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TRANSACTIONS 

& 

STUDIES 




of 

THE COLLEGE OF PHYSICIANS 
OF PHILADELPHIA 



MEDICINE & HISTORY 

Series V Volume XIV No. 1 MARCH 1992 



CAROLINE HANNAWAY, Editor 
CARLA C. JACOBS, Managing Editor 



College of Physicians of Philadelphia 

Officers 

Daniel L. Shaw, Jr., M.D., President 
Robert H. Bradley, Jr., M.D., President Elect 
John L. McClenahan, M.D., Secretary 
Joseph A. Wagner, M.D., Treasurer 
John M. O'Donnell, Ph.D., Executive Director 



Council 

Mark W. Allam, V.M.D. 
Robert Austrian, M.D.* 
Lewis W. Bluemle, Jr., M.D. : 
Robert H. Bradley, Jr., M.D. 
Lewis L. Coriell, M.D., Ph.D.* 
Richard A. Davis, M.D. 
John W. Eckman 
William C. Frayer, M.D. 
William L. Kissick, M.D. 
Charles T. Lee, Jr., M.D. 
Edithe J. Levit, M.D. 
John L. McClenahan, M.D. 
Emily H. Mudd, Ph.D. 



* Former President 



Frederick Murtagh, M.D. 
James A. O'Neill, M.D. 
Ann O'Sullivan, R.N., Ph.D. 
Robert S. Pressman, M.D.* 
Edward J. Resnick, M.D. 
Jonathan E. Rhoads, M.D.* 
Brooke Roberts, M.D.* 
George P. Rosemond, M.D. :: " 
Robert G. Sharrar, M.D. 
Daniel L. Shaw, Jr., M.D. 
Edward J. Stemmler, M.D. 
Joseph A. Wagner, M.D. 



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TRANSACTIONS 

& 

STUDIES 




of 

THE COLLEGE OF PHYSICIANS 
OF PHILADELPHIA 



MEDICINE & HISTORY 

Series V Volume XIV No. 1 MARCH 1992 



Acknowledgments 



The publication of this issue of Transactions & Studies of the 
College of Physicians of Philadelphia is made possible through the 
generosity of: 

The M. Louise Carpenter Gloeckner Memorial Fund 

The Morris Feld Memorial Fund 



Copyright © 1992 by The College of Physicians of Philadelphia 



TRANSACTIONS & STUDIES 
OF THE 

COLLEGE OF PHYSICIANS OF PHILADELPHIA 

Series V Volume XIV Number 1 March 1992 

MEDICINE AND HISTORY 

Contributors to This Issue v 

The Emergence of Medical Malpractice 
In America 

JAMES C. MOHR 1 

Revolt Against Quarantine: Community 
Responses to the 1916 Polio Epidemic, 
Oyster Bay, New York 

GUENTER B. RISSE 23 

A Tale of Pursuing Health Deception 

JAMES HARVEY YOUNG 51 

FROM THE FELLOWSHIP 

James W. Kennedy, M.D. and the Joseph 
Price Memorial Hospital: Recollections 

FREDERICK MURTAGH 73 

FROM THE HISTORICAL COLLECTIONS 

"An Indescribable Feeling of Wretchedness": 
Letters to Samuel Jackson on Epilepsy 

JACK ECKERT 83 

Report of the President of the College 
of Physicians at the Annual Meeting of 
the Fellowship, 26 November 1991 

DANIEL L. SHAW, JR. 101 

BOOK LIST 107 

REVIEWS 

PHILIP R. REILLY, The Surgical Solution: A History 
of Involuntary Sterilization in the United States 
Reviewed by Leila Zenderland 111 



in 



Contents 



EMIL FREIREICH and NOREEN A. LEMAK, 

Milestones in Leukemia Research & Therapy 
Reviewed by Jacalyn Duffin 

ALLEN B. WEISSE, Medical Odysseys: The Different 
and Sometimes Unexpected Pathways to 
Twentieth-Century Medical Discoveries 
Reviewed by Robert H. Bradley, Jr. 

ROBERT GALLO, Virus Hunting: AIDS, Cancer, 
& the Human Retrovirus: A Story of 
Scientific Discovery 
Reviewed by Robert G. Sharrar 

OWSEI TEMKIN, trans., Soranus' Gynecology 
Reviewed by A. Deborah Goldstein 

J. WORTH ESTES, Dictionary of Protopharmacology: 
Therapeutic Practice, 1700-1850 
Reviewed by John Harley Warner 

WENDY MITCHINSON, The Nature of Their Bodies: 
Women and Their Doctors in Victorian Canada 
Reviewed by Rima D. Apple 

KATHRYN MONTGOMERY HUNTER, Doctors' 
Stories: The Narrative Structure of Medical 
Knowledge 

Reviewed by Julia Epstein 

EDWARD NORBECK and MARGARET LOCK, eds., 
Health, Illness, and Medical Care in ]apan: 
Cultural and Social Dimensions 
Reviewed by Ann Bowman Jannetta 

WILLIAM J. ELLOS, Ethical Practice in Clinical 
Medicine 

Reviewed by David G. Smith 

MEMOIR 



C. William Hanson, Jr. (1929-1991) 
ORVILLE HORWITZ 



Contributors To This Issue 



RIMA D. APPLE, Ph.D. is Associate Editor of the journal Isis and 
a member of the Women's Studies Program at the University of 
Wisconsin-Madison. She is the editor of Women, Health, and Medi- 
cine in America: A Historical Handbook (New York: Garland, 
1990; New Brunswick, N.J.: Rutgers University Press, 1992). 

ROBERT H. BRADLEY, JR., M.D. is retired Chief of Urology at 
Chestnut Hill Hospital and Honorary Clinical Associate Professor 
of Urology at Thomas Jefferson University Medical School. A Fel- 
low of the College of Physicians since 1971, Dr. Bradley is currently 
President-Elect of the College. 

JACALYN DUFFIN, M.D., Ph.D. is the Jason A. Hannah Professor 
of the History of Medicine at Queen's University at Kingston, On- 
tario, Canada. A hematologist and historian, her research interests 
include medicine in post-Revolutionary France and in nineteenth- 
century Canada. 

JACK ECKERT, M.A. is Curator of Archives and Manuscripts in 
the Historical Collections of the Library of the College of Physicians 
of Philadelphia. 

JULIA EPSTEIN, Ph.D. is Associate Professor of English and Chair 
of the Program in Comparative Literature at Haverford College. 
She is currently working on a book on explanatory narratives in 
medicine. 

A. DEBORAH GOLDSTEIN, M.D. is a Staff Physician at St. Chris- 
topher's Hospital for Children. Dr. Goldstein, who recently became 
a Fellow of the College of Physicians, is working to complete the 
dissertation requirements for a doctorate in Classical Greek at Bryn 
Mawr College. 

ORVILLE HORWITZ, M.D. is Emeritus Professor of Medicine 
and Emeritus Professor of Pharmacology at the University of Penn- 
sylvania School of Medicine, and the founder and President of the 
Foundation for Vascular-Hypertension Research. Dr. Horwitz is a 
Fellow of the College of Physicians. 



VI 



Contributors 



ANN BOWMAN JANNETTA, Ph.D. is Assistant Professor of His- 
tory at the University of Pittsburgh. She is the author of Epidemics 
and Mortality in Early Modern Japan (Princeton, N.J.: Princeton 
University Press, 1987) and is currently at work on a history of 
vaccination in nineteenth-century Japan. 

JAMES C. MOHR, Ph.D. is Professor and Chair of the Department 
of History, University of Maryland, Baltimore County. He has writ- 
ten several books and articles on various aspects of nineteenth- 
century American politics and social policy. His study of nineteenth- 
century American medical jurisprudence, tentatively titled Doctors 
and the Law, will be published by Oxford University Press in 1993. 

FREDERICK MURTAGH, M.D., M.Sc. is Emeritus Professor of 
Neurosurgery at the University of Pennsylvania and formerly Pro- 
fessor of Neurosurgery at Temple University. A Fellow of the Col- 
lege of Physicians since 1955, he is the author of several 
biographical journal articles on prominent men in medicine. 

GUENTER B. RISSE, M.D., Ph.D. is Professor and Chair, Depart- 
ment of the History of Health Sciences, University of California, 
San Francisco. He is interested in the history of epidemics and 
hospitals and is the author of Hospital Life in Enlightenment Scot- 
land (New York: Cambridge University Press, 1986). 

ROBERT G. SHARRAR, M.D., M.Sc. is the Director, Drug Experi- 
ence and Epidemiology for Merck, Sharp & Dohme Research Labo- 
ratories and the former Assistant Health Commissioner for Disease 
Prevention for the Philadelphia Department of Public Health. Dr. 
Sharrar has been a Fellow of the College of Physicians since 1976. 

DANIEL L. SHAW, JR., M.D. is President of the College of Physi- 
cians of Philadelphia, and a Fellow of the College since 1956. Dr. 
Shaw is the former Vice President of Wyeth Ayerst. 

DAVID G. SMITH, M.D. is the Associate Program Director, Inter- 
nal Medicine Residency at Abington Memorial Hospital, Abington, 
Pennsylvania and Assistant Professor of Medicine at the Temple 
University School of Medicine. Dr. Smith has been a Fellow of the 
College of Physicians since 1984. 



Contributors 



vii 



JOHN HARLEY WARNER, Ph.D. is Associate Professor of the 
History of Medicine at Yale University and author of The Therapeu- 
tic Perspective (1986). He is now working on Against the Spirit 
of System: The French Impulse in Nineteenth-Century American 
Medicine. 

JAMES HARVEY YOUNG, Ph.D. is Charles Howard Candler Pro- 
fessor Emeritus of American Social History at Emory University. 
His American Health Quackery: Collected Essays is in press, and 
he is currently at work on a study of the enforcement of the Food 
and Drugs Act of 1906 until that law was replaced in 1938. 

LEILA ZENDERLAND, Ph.D. is Associate Professor of American 
Studies at California State University, Fullerton. She is currently 
completing a book entitled Measuring Minds: Henry Herbert God- 
dard and the Origins of American Intelligence Testing. 



1 


Digitized by 


the Internet Archive 








in 2013 







http://archive.org/details/transactionsstud5141 coll 



The Emergence of Medical Malpractice 
in America 



JAMES C. MOHR 

Issues surrounding medical malpractice have come to dominate 
discussions of medical jurisprudence in the United States in modern 
times. Indeed, for a surprisingly large number of contemporary 
Americans, especially physicians, malpractice and legal medicine 
have become all but synonymous. A medico-legal world in which 
malpractice was not a prominent problem now seems to them both 
fancifully idealistic and almost inconceivable. It may come as a 
shock to many contemporary doctors and lawyers, therefore, to 
learn that medical malpractice litigation was not a serious medico- 
legal concern in the United States before 1840, even among the 
leading scholars of medical jurisprudence. But with striking speed 
thereafter, medical malpractice broke dramatically into American 
popular and professional consciousness to become a major issue for 
the nation's medico-legalists. Indeed, after 1850 medical malprac- 
tice would begin to alter the way physicians approached the subject 
of medical jurisprudence in America. 

The basic concept of professional malpractice had existed in 
Anglo-American legal theory prior to the American Revolution, for 
William Blackstone referred specifically to malpractice in the fa- 
mous Commentaries on the Laws of England he published during 
the 1760s. Moreover, Blackstone had linked the concept explicitly 
to the medical profession by including under mala praxis "Injuries 
. . . by the neglect or unskillful management of [a person's] physi- 
cian, surgeon, or apothecary . . . because it breaks the trust which 
the party had placed in his physician, and tends to the patient's 
destruction." 1 The Commentaries were widely read in the colonies 



In a somewhat altered form, this article was presented at the Francis C. Wood 
Institute for the History of Medicine of the College of Physicians of Philadelphia on 
28 February 1991, as part of the "Law and Medicine" program. 

1. William Blackstone, Commentaries on the Laws of England (facsimile reprint 
of the first edition), Volume III, Of Private Wrongs (originally 1768), Chapter 8, p. 
122. In various forms, of course, the concept of medical malpractice far predated 
Blackstone as well, though they are less germane to the situation in the United States. 
See, for example, Michael T. Walton, "The Advisory Jury and Malpractice in 15th 
Century London: The Case of William Forest," Journal of the History of Medicine, 
1983,40:478-482. 

1 

Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 1-21 
© 1992 by James C Mohr 



2 



James C. Mohr 



and remained influential through the early national period. But as 
a practical matter, actions for medical malpractice were seldom 
initiated in American professional situations through the first third 
of the nineteenth century. And even at a theoretical level, the con- 
cept of medical malpractice was so arcane and unimportant in the 
early republic that American writers on medical jurisprudence, 
those most likely to be interested in the subject as an aspect of legal 
medicine, did not bother to address it through the first four decades 
of the nineteenth century. Theodric Romeyn Beck's Elements of 
Medical Jurisprudence, by far the most authoritative and exhaustive 
treatise of the period, never mentioned malpractice from its first 
publication in 1823 through its mid-century editions, though the 
latter began to approach two thousand pages in length and were 
considered encyclopedic in the breadth of their coverage. Neither 
did standard legal treatises on evidence and proof. 

In 1834 Robert Eglesfeld Griffith of Philadelphia, one of the 
best-informed medico-legal writers and editors in the country, noted 
the total absence of any American study of "medical responsibility," 
by which he meant the standards of competence appropriate to 
various types of cases and various geographical regions. In fact, like 
many other physicians of the early period, he complained that the 
legal doctrines governing malpractice were too murky and unen- 
forceable; complete charlatans could probably plead ignorance and 
escape the consequences of whatever harm they might do to fellow 
citizens. 3 As late as 1855, the first edition of Francis Wharton and 
Moreton Stille's A Treatise on Medical Jurisprudence, which sup- 
planted Beck's Elements as the dominant treatise in the field during 
the third quarter of the nineteenth century, still contained no refer- 
ence to medical malpractice, though by then it probably should 
have. 4 



2. Theodric Romeyn Beck's Elements of Medical Jurisprudence (Albany, N.Y.: 
Webster and Skinner, 1823), a world famous book, went through 12 editions be- 
tween 1823 and 1863. For a key example from the legal literature, see Thomas 
Starkie, A Practical Treatise on the Law of Evidence, and Digest of Proofs in 
Civil and Criminal Proceedings, With References to American Decisions, By Theron 
Metcalf, 8th American edition from the 4th London edition (Philadelphia, Pa.: T. 
and J. W. Johnson, 1860). This multi-volume work, the most often cited in its field, 
does not address medical malpractice. 

3. Robert Eglesfeld Griffith, review of Adolphe Trebuchet, Jurisprudence de la 
medecine, de la chirurgie, et de la pharmacie, en France (Paris: Bailliere, 1834), in 
American Journal of Medical Science, 1834-1835, 15:168-170. 

4. Francis Wharton and Moreton Stille, A Treatise on Medical Jurisprudence 
(Philadelphia, Pa.: Kay and Brother, 1855). 



Emergence of Medical Malpractice 



3 



This is not to say that medical malpractice cases were com- 
pletely unknown in the United States before the year 1840. In 1827, 
for example, the Beck brothers' New York Medical and Physical 
Journal reported a case of obvious and special interest to those who 
urged closer cooperation between the medical profession and the 
government. The events that led to the case had taken place in 1824. 
That spring the City of New York hired physicians to canvass 
Manhattan by districts and vaccinate at public expense anyone 
who had not already been protected against a cresting epidemic of 
smallpox. One of the physicians hired, a young practitioner named 
Gerard Banker, vaccinated some 870 citizens in his district, many 
of whom were children. One of those children, a two-year-old, 
subsequently died a hideous and horrible death from the disease, 
and the child's father sued Banker for inflicting smallpox upon the 
child through a bad inoculation. 5 

Though Banker was acquitted when other city physicians testi- 
fied that the child was probably coming down with the disease at 
the time Banker performed the vaccination, the case might have 
had a chilling effect upon future cooperation between the medical 
profession and public authorities had the decision gone the other 
way; that was no doubt the reason the New York Medical and 
Physical Journal publicized the case. Moreover, Banker's defense 
attorney had also tried to make as plain as possible to individual 
physicians the potential danger of this sort of accusation. "The case 
is of vast importance to the defendant," he argued, because the 
young doctor had "chosen a profession, to the study of which, he 
has already devoted many years of his life, and a verdict in this case 
against him, is his professional death." 6 

Other scattered cases occurred during the 1820s. Two obscure 
practitioners in Maine, for example, were sued in a case involving 
the treatment of a hip injury incurred in 1821. That case dragged 
on nearly five years, gained national attention, and eventually pitted 
John Warren, a leader of the Boston medical establishment, against 
Nathan Smith, a New England rival who helped establish both the 
Dartmouth Medical School and the Yale Medical School, at least 
in part to offset the dominance of the Harvard-based Boston group. 



5. "Michael O'Neil vs. Gerard Bancker," New York Medical and Physical Jour- 
nal, 1827, 6:145-152. Irregularities occur in the spelling of the physician's name, 
but it is rendered throughout the text of the story as Banker. That spelling will be 
used here. 

6. "Michael O'Neil vs. Gerard Bancker," p. 151. 



4 



James C. Mohr 



Yet reports of the case revealed clearly that one of the chief reasons 
for its notoriety lay in its novelty. Indeed, attorneys in the case were 
not sure exactly how to phrase the court action they were trying to 
take. Later in the decade Nathan Smith told his medical jurispru- 
dence class at Yale about that case and about a small handful of 
other malpractice actions that he was aware of in Connecticut dur- 
ing the 1820s. But Smith, who had been personally involved in the 
most famous medical malpractice case in the nation's history to that 
time and who was in a position to know such things, remarked 
to his Yale students that he "Never knew but one case sued for 
Malpractice in medicine [as distinguished from surgery]," and he 
seemed to suggest that more aggressive legal activity on the malprac- 
tice front might prove salutary for the medical profession in the 
long run, since under the doctrines in force in Connecticut in 1827, 
"the most egregious Quacks must escape punishment." 8 

Notwithstanding the foregoing examples, then, malpractice 
cases involving physicians were sufficiently few in number through 
the first 50 years of the republic to be reasonably characterized as 
isolated, though sometimes troubling, curiosities. 9 Certainly medi- 

7. Many of the principals in this well-known case, Lowell v. Hawks and Faxon, 
ended up publishing their own version of what they considered most important 
about the affair. See, for example, Charles Lowell, An authentic report of a trial 
before the Supreme judicial court of Maine, for the county of Washington, June term, 
1824: Charles Lowell vs. John Faxon & Micajan Hawks, surgeons and physicians, in 
an action of trespass on the case for ignorance and negligence (Portland, Maine, 

1825) ; Charles Lowell, Report of the trial of an action, Charles Lowell against John 
Faxon and Micajah Hawks, doctors of medicine, defendants, for malpractice in the 
capacity of physicians and surgeons, at the Supreme judicial court of Maine, holden 
at Machias for the county of Washington — June term, 1824. Before the Hon. 
Nathan Weston, Jun., Justice of the court (Portland, Maine: James Adams, Jr., 1 825); 
and the public letter issued by John C. Warren: A Letter to the Hon. Isaac Parker, 
Chief Justice of the Supreme Court of the State of Massachusetts, Containing Re- 
marks on the Dislocation of the Hip Joint, Occasioned by the Publication of a Trial 
which took place at Machias, in the State of Maine, June, 1824 (Cambridge, Mass., 

1826) . 

8. " 'Medical Jurisprudence' by Nathan Smith," lecture notes by Avery J. Skelton 
taken at Yale University; probably in February 1827, p. 138. Manuscript Collection, 
History of Medicine Division, National Library of Medicine, Bethesda, Maryland. 

9. The standard essay on this subject for some time has been Chester R. Burns, 
"Malpractice Suits in American Medicine Before the Civil War," Bulletin of the 
History of Medicine, 1969, 43:41-56. Burns, in turn, had benefitted from the 
surveys by Hubert W. Smith, "Legal Responsibility for Medical Malpractice, IV: 
Malpractice Claims in the United States and a Proposed Formula for Testing Their 
Legal Sufficiency," JAMA, 1941, 1 1 6:2670-2679, and Andrew A. Sandor, "The 
History of Professional Liability Suits in the United States," JAMA, 1957, 
163:459-466. More recently, Kenneth A. De Ville completed a monograph that has 
added enormously to this and related inquiries about medical malpractice in the 
United States during the nineteenth century. De Ville was kind enough to share his 



Emergence of Medical Malpractice 



5 



cal journals, even though they had a prima facie interest in malprac- 
tice developments and even though they evinced a strong and 
growing interest in most other types of medico-legal topics after 
1820, rarely mentioned malpractice cases prior to 1840 and did not 
betray any special misgivings about the isolated ones they happened 
to come across. The precise number of medical malpractice actions 
at any given point in the century cannot be determined. Even if 
armies of patient researchers were available to survey all legal ac- 
tions in all jurisdictions at all levels, many, if not most, of the 
records were never saved in the first place or have subsequently 
been lost or destroyed. Consequently, despite obvious drawbacks, 
legal historians have used state appellate cases as a sort of statistical 
surrogate in situations of this sort. By that measure, only 2 percent 
of the medical malpractice cases to reach American state appellate 
courts between 1790 and 1900 were reported in the period before 
1835. 10 Kenneth De Ville, who has made the most recent and most 
thorough assessment of those cases, also noted that the period from 
1790 to 1840 was the only period in American history in which the 
rate of population growth easily exceeded the rate of increase in 
medical malpractice cases. 11 

After 1840, the frequency of malpractice actions shot suddenly 
upward, and well-established physicians, not charlatans, found 
themselves the targets of an almost revolutionary and certainly 
unprecedented surge in malpractice accusations. As a result, what 
had appeared for half a century to be a potentially beneficent curios- 
ity was transformed in the perception of well-educated regular 
American physicians in less than a decade into an anti-professional 
specter of high visibility and ominously destructive power. That 
change in the role of medical malpractice in American professional 
life, in turn, quickly proved to be yet another of the mid-century 



manuscript with me prior to its publication. References here are to that manuscript. 
The book itself, which is now available, is Kenneth Allen De Ville, Medical Malprac- 
tice in Nineteenth-Century America: Origins and Legacy (New York: New York 
University Press, 1990). 

10. De Ville, Medical Malpractice, pp. 1—5. The 2.3 percent represented 5 of 
the 216 total cases. What percentage of all medical malpractice cases reached appel- 
late courts, of course, is also impossible to judge. There is some reason to use a 1 
percent ratio for later periods, but that seems a bit low for the early period, when 
malpractice cases, precisely because they were oddities, might more likely be ap- 
pealed. In any event, it seems safe to state that fewer than five hundred medical 
malpractice actions were brought in all American courts combined prior to 1835, 
and the total might very probably be much lower than that. 

11. De Ville, Medical Malpractice, pp. 4-5 and Table 1. 



6 



James C. Mohr 



developments that widened the gap between law and medicine and 
pushed the field of medical jurisprudence farther toward the mar- 
gins of American professional development. 

Though historians have only begun to explore this striking and 
intriguing transition, some of the broad outlines of what happened 
are relatively clear. The same socio-political and ideological ethos 
that blocked state support for medical jurisprudence during the 
1830s had begun by the 1840s to transform physicians from com- 
munity helpers into contract agents. Doctors no longer looked like 
designated healers or well-meaning neighbors who served their local 
communities as best they could in an interactive and organic social 
system that involved mutual trust and obligations. Instead, doctors 
looked more and more like individual entrepreneurs in an intensely 
competitive marketplace. Under those altered circumstances, in- 
creasing numbers of patients decided that the physician-agents they 
retained could have and should have done a better job than they 
did. Rather than pay their doctors for doing as well as they could 
under the conditions at hand, an increasing number of patients 
instead sued their doctors for failing to prevent or for apparently 
inflicting permanent disabilities and deformities, for failing to de- 
liver on an implied contract of full recovery or restoration. 

Shifting public attitudes may also have been fueled by perfec- 
tionist health and fitness movements that swept the nation during 
the 1840s, for those movements almost certainly raised people's 
expectations of what was considered normal in matters of health 
and made people more sensitive to physical well-being. Some histo- 
rians argue that the era also experienced a corresponding decline in 
the number of people still prepared to dismiss bodily suffering in a 
religiously fatalistic fashion. A surge of aggressive and flamboyant 
medical advertising during the late 1830s and early 1840s offered 
the general public a host of false promises, further adding to general 
expectations. The steady nationalization of the new medical market- 
place probably also played a role in the advent of widespread mal- 
practice litigation, for standards of care once considered not only 
adequate but uniquely appropriate to a particular local region began 
to seem inferior and erroneous in comparison to results claimed or 
obtained elsewhere. Changes in the technical rules of legal pleading 



Emergence of Medical Malpractice 



7 



during this same period, moreover, had the effect of further easing 
the process of bringing malpractice actions in the first place. 

In any event, the new "contagion" of lawsuits, as physicians 
characterized the phenomenon in a typically medical metaphor, 
seemed to become virulent almost overnight. At first centered in 
western New York State, a sharp surge in the frequency of malprac- 
tice cases was evident throughout New England and the upper Mid- 
West by mid-century. Even though exact numbers for the period 
remain impossible to calculate, and even though the rates of mal- 
practice actions were probably lower than they have come to be 
in the twentieth century, the evidence is overwhelming that "the 
profession and the country crossed over the most critical threshold 
in the 1840s and 1850s." Malpractice cases carried to state appel- 
late courts roared ahead 950 percent between 1830 and 1860, while 
the nation's population increased 144 percent, and almost all of the 
increase in malpractice appeals took place after 1840. 14 Medical 
journals, after decades of barely noticing malpractice on the medical 
horizon, reacted defensively with strong and frequent articles and 
editorials. 

The public's increasingly frequent recourse to medical malprac- 
tice suits in the 1840s may be seen in retrospect as a perfectly 
reasonable response to the marketplace professionalism which was 
then emerging in the United States. Anti-monopolistic sentiment 
during the 1830s, after all, had precluded the creation of profes- 
sional structures that might have permitted some degree of self- 
regulation by the medical profession: structures such as licensing 
qualifications to insure minimal competence or government-ap- 
pointed physicians to provide a public standard. Halting experi- 
ments designed to encourage internal settlements within local 
medical societies proved quickly and utterly ineffectual in the face 
of intense personal rivalries inside the societies and accusations 
from healers outside the societies. 15 Consequently, individual prac- 
titioners, one at a time, would have to be held to standards deemed 
acceptable by those who retained their services. Quality control 

12. De Ville, Medical Malpractice, discusses many of these and other factors. 
On the erosion of therapeutic differences by region, see John Harley Warner, The 
Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 
1820-1885 (Cambridge, Mass.: Harvard University Press, 1986). 

13. De Ville, Medical Malpractice, p. 45. 

14. De Ville, Medical Malpractice, Table 1, p. 4. 

15. "Doings of the Courtland County (New York) Medical Society," Boston 
Medical and Surgical Journal, 16 February 1842, 26:33-34. 



8 



James C. Mohr 



would come not from self-policing by medical providers, since that 
was too dangerous for other reasons and historically ineffective in 
any event, but from the people who paid the bill. Indeed, if the 
concept of medical malpractice had not already existed in Anglo- 
American legal theory, Americans might have been forced to invent 
it; in seizing upon an arcane doctrine and changing the rules of 
pleading to ease its employment, Americans essentially did just that. 

At least in theory, the nation's strongest physicians might have 
welcomed the sudden and dramatic increase in the number of mal- 
practice suits as a useful alternative method of driving charlatans 
and amateur hacks from the field. The general public and the legal 
profession might have been enlisted as allies in an effort to improve 
medical care. The early champions of medical jurisprudence, after 
all, had cautiously endorsed the positive potential of malpractice 
litigation and envisioned lawyers not as hostile attackers but as 
partners in a process of professional purification. Over and over 
during the 1840s and 1850s, however, the nation's best-educated 
and most professionally-minded physicians observed with a sort of 
defensive incredulity and disbelieving horror that many, if not most, 
of the burgeoning numbers of malpractice suits were being lodged 
not against charlatans and amateur hacks, but against others like 
themselves: successful regular doctors. What early commentators 
like Griffith and Smith once considered a potentially useful mecha- 
nism had somehow quickly and alarmingly come to be a means of 
persecuting the best physicians then practicing. 

Several factors help explain why the best-educated and most 
successful physicians, rather than the nation's army of amateurs 
and alternative healers, became disproportionately frequent targets 
for malpractice suits in the 1840s. First, they became ironic victims 
of their own medical advancement. The vast majority of the law- 
suits that constituted the first great wave of malpractice litigation 
at mid-century involved orthopedic cases in which a limb had healed 
to a shortened, deformed, or frozen position following compound 
fracture. Patients found themselves with an unambiguous, easily 
demonstrated, and obviously measurable problem and sued the 
doctor who set the bone fragments and dressed the wound. What 
made this situation ironic was the fact that 20 years earlier most 
compound fractures would have led to amputation. The patient 
would have no limb at all, but no malpractice case either, since the 
doctor would have been following safe and standard procedures. 
Improved techniques and more careful training produced an ad- 



Emergence of Medical Malpractice 



9 



vance; but because the consequences of the advance were often 
imperfect, those who tried to save limbs in difficult cases often 
found themselves being sued. 

Second, the better the physician, the more likely he would be 
to take a difficult compound fracture case in the first place and the 
more likely he would be to try to save the limb, even if it survived 
in less than perfect shape. The techniques involved in saving com- 
pound fractures in the 1830s, while still avoiding the dangers of 
internal infection that previously made amputation necessary to 
save the life of the patient, required sophisticated knowledge of 
wound dressing and bone setting that amateurs or inexperienced 
healers would never pretend to possess. 

Third, amateurs and alternative healers delivered what patients 
came to them for, be it hot baths or herbal teas, and could not be 
sued for undesirable results (in theory they could have been sued 
for concocting their own teas erroneously, but in practice they 
claimed no standard recipes and made a virtue of treating each case 
individually). Regular physicians, on the other hand, could have the 
very body of educational texts and advanced manuals they were 
steadily producing used in court against them as standards or norms 
from which they could be accused of deviating. William Rothstein 
and others have pointed out the sometimes deceptive truism that 
malpractice is virtually impossible to demonstrate in the absence of 
practice; no one can be convicted of doing established procedures 
poorly, if no procedures have been established. 16 Writing from Erie, 
Pennsylvania, in 1849, William Wood, a United States Navy doctor, 
understood the frustrations of that principle all too well. "It is better 
to be without a diploma" in the current climate, he concluded 
ruefully, because then a "practitioner can say, 'I make no preten- 
sions, I offer no certificate of ability, and only gave my neighbour 
in his sufferings such aid as I could.' " 17 

Finally, patients had little or no incentive to sue marginal heal- 
ers with few assets, but substantial incentive to sue the most prosper- 
ous physicians, from whom they might actually collect. That 
incentive, superimposed upon the anti-elite, anti-monopoly, and 



16. William G. Rothstein, American Physicians in the Nineteenth Century: 
From Sects to Science (Baltimore, Md.: The Johns Hopkins University Press, 1972), 
pp. 324-325. 

17. William Wood, "Thoughts on Suits for Malpractice, Suggested by Certain 
Judicial Proceedings in Erie County, Pennsylvania," American journal of Medical 
Science, 1849, 1 8:400. 



10 



James C. Mohr 



anti-professional ethos of the 1830s and 1840s, gave the nation's 
first medical malpractice crisis a distinctly class-oriented aspect. 
Physicians near the top of their profession certainly saw class as a 
factor in the crisis. Many of them thought that the vast majority of 
malpractice suits were initiated by poor patients either trying to 
escape paying for a job they considered less than perfect or trying to 
turn a misfortune into cash at the expense of a wealthy professional. 
Medical societies reconsidered their obligations to treat the poor; 
impecunious patients were made to post bonds against subsequent 
legal actions before receiving medical treatment; and medical 
spokesmen railed against the use of a long-dormant legal doctrine 
for the purpose of shaking down the nation's better physicians, 
since a doctor often found it easier to forgive the bill or settle a claim 
out of court than to fight the accusation and risk his reputation and 
his whole practice. 18 

In a most revealing comment, Walter Channing at Harvard 
was appalled at reports of "a certain county, of a certain State, 
[where] the jury in all suits for malpractice give their verdict for the 
plaintiff; and that same county, it is said, tries more of such cases 
than all the others of the Commonwealth put together." 19 Under 
the circumstances, Channing's pointed emphasis of the word com- 
monwealth was almost certainly intended to be mocking. The con- 
cept of society which that hopeful word once evoked for republican 
state-makers in an earlier era, Channing was suggesting, no longer 
seemed to exist in the United States by the middle of the nineteenth 
century. 

Channing had become convinced that the only antidote to the 
malpractice contagion would be the creation of special medical 
juries to try malpractice accusations. Other professions already en- 
joyed that perfectly reasonable and logical privilege in the Anglo- 
American legal tradition, he argued. "In both army and navy, offi- 
cers are tried by their peers — by themselves," and clergy, when 
challenged on questions "relating to their profession," were judged 
by other clergy. But the citizens who ended up on ordinary American 
juries were in no sense peers of the physicians whose efforts they 



18. De Ville, Medical Malpractice, pp. 373-459. All of these trends are evident 
as well in many articles that appeared during the 1840s and 1850s in the nation's 
leading contemporary medical journals. 

19. Walter Channing, "A Medico-Legal Treatise on Malpractice and Medical 
Evidence — A Review," Boston Medical and Surgical Journal, 1860, 62:306; empha- 
sis in the original. 



Emergence of Medical Malpractice 11 



were now being asked to assess. Common juries tended not to 
evaluate physicians, but to attack them. 20 

The malpractice crisis of mid-century also widened the gap 
between physicians and lawyers. That gap had already been opened 
by previous professional confrontations over expert medical testi- 
mony, but quickly became a chasm in the context of malpractice. 
Many prominent physicians believed that the general public, and 
especially the poor, would not be attacking the doctors who helped 
them, often for little or no fee, unless they were incited by self- 
seeking and professionally irresponsible attorneys. By mid-century, 
the Boston Medical and Surgical Journal was referring to geographi- 
cal areas where actions for malpractice proliferated as "law-infected 
districts." 21 And there is some evidence that lawyers did encourage 
one another to keep expanding what appeared to be a new growth 
market for their services. In 1849, for example, the American Law 
Journal noted with disgust that the death of a patient during neck 
surgery had been ruled accidental. The Journal suggested that the 
same standards of liability should apply in medical cases that ap- 
plied in any other dangerous trade. The editor likened physicians 
to boiler mechanics: the former should be as liable as the latter if 
clumsiness or lack of real knowledge led to an explosion. 22 The 
Journal likewise considered deaths and complications that followed 
the administration of anesthetics, which were just beginning to 
come into widespread use among American physicians, a potentially 
fertile new field for lawyers to cultivate more aggressively. 23 

Physicians particularly deplored the contingent fee system, 
which lawyers began to employ frequently in the middle decades 
of the nineteenth century in malpractice cases. Under that system 
plaintiffs risked nothing in bringing charges, then split with their 
attorneys some portion of any judgment they were able to win in 
or out of court. Physicians denounced those arrangements and tried 
repeatedly to have them declared illegal or unethical. But they 
gained little headway in the face of egalitarian arguments that every 
citizen had the right to bargain for legal representation on the best 

20. Channing, "Medico-Legal Treatise," pp. 233-241, 259-265, and 300-307. 

21. "Medical Miscellany," Boston Medical and Surgical Journal, 20 February 
1850, 42:67. 

22. American Law Journal, 1849, 1 :284-285. 

23. American Law Journal, 1849, 2:284; 1849-1850, 2:330-333. On the 
adoption of anesthetics, see Martin Pernick, A Calculus of Suffering: Pain, Profes- 
sionalism, and Anesthesia in Nineteenth-Century America (New York: Columbia 
University Press, 1985). 



12 



James C. Mohr 



terms available, whether cash was in hand or in prospect. By the 
1880s the American Medical Association regarded "a large propor- 
tion" of malpractice actions as having "no other foundation than a 
desire to extort money from the defendant sufficient to secure a 
good fee for the prosecuting counsel." 24 Medical journals likewise 
castigated what they considered to be illegal fishing expeditions long 
after the fact, since litigants during the 1840s were beginning to 
receive large settlements for alleged suffering that occurred years 
after the operation at issue had been performed. 25 Physicians were 
appalled in the early 1850s when lawyers also began to sue physi- 
cians for what they did not do, thereby cashing in on an implied 
responsibility to treat the public that popular newspapers of the 
1850s also asserted. 26 

The expression of anti-lawyer sentiments, which had not been 
a strong theme in doctors' discourse before 1840, became both 
common and blatant after mid-century whenever physicians dis- 
cussed malpractice. To cite a single prominent example, Eugene 
Sanger, a physician whose 1878 survey of medical malpractice in 
Maine was one of the most systematic of the early sources of 
information about the growing phenomenon, believed that malprac- 
tice attorneys "follow us as the shark does the emigrant ship." 27 
Many of his fellow physicians before him and after were less meta- 
phorical and less subtle. It would be easy to fill several hundred 
pages full of vituperative, anti-legal rhetoric from medical journals 
after mid-century, but there is little reason to do so here. In the 
twentieth century, Americans have become accustomed to strained 
relations and strong opinions whenever physicians discuss lawyers 
in the context of malpractice. Suffice it to say that the origins of 
those now axiomatic sentiments lie in the period between 1840 and 
1860. 

The malpractice crisis also began to reshape the teaching of 
medical jurisprudence in medical schools. To oversimplify, medical 
students no longer wanted their professors of medical jurisprudence 



24. JAMA, 1887, p. 839. 

25. "Medical Miscellany," Boston Medical and Surgical Journal, 7 October 
1846, 35:207. 

26. "Liability of Physicians and Surgeons," Boston Medical and Surgical Jour- 
nal, 20 July 1853, 48:506-507. 

27. The quote is from "Medical Notes," Boston Medical and Surgical Journal, 
1878, 100:91. The larger report is Eugene F. Sanger, "Report of the Committee 
on Suits for Malpractice," Transactions of the Maine Medical Association, 1878, 
6:360-382. 



Emergence of Medical Malpractice 13 



to tell them how to become more effectively involved in the nation's 
legal system; they wanted to know how to avoid involvement alto- 
gether or at least how to escape with minimal disruption. A near 
perfect illustration of that long-term shift within medical schools 
occurred at the Geneva Medical College exactly at mid-century. 

The place, the professor, and the date all seemed symbolic. 
Geneva Medical College, then a prominent institution with a faculty 
considered among the most able in the nation, was located squarely 
in the middle of western New York, the area in which the malprac- 
tice crisis seemed to originate. 28 By the middle of the 1840s, in fact, 
western New York had already gained a legendary reputation, in 
the oft-quoted characterization of the Boston Medical and Surgical 
Journal, as "dangerous ground for a surgeon." 29 An especially nasty 
malpractice case in nearby Cortland in 1841 had dragged on for 
years and disrupted the region's local medical societies. 30 Frank 
Hamilton, the well-educated and prominent physician from Buffalo 
who would eventually publish data demonstrating statistically pre- 
dictable variations in compound fracture cases in order to undercut 
what he considered to be the unrealistic claims of those whose 
healing had been less than perfect, estimated that nine out of every 
ten physicians in western New York had been charged with malprac- 
tice by mid-century. 31 The students at Geneva, many of whom no 
doubt hoped to practice in the otherwise prosperous and economi- 
cally attractive districts of western New York, could not have been 
unaware of the malpractice crisis. 

The professor who taught medical jurisprudence at Geneva 
through most of the 1840s was James Webster, a prototype of the 
able young professionals who had been drawn to the field in the 
1820s and 1830s. Webster had earned his M.D. from the College 
of Physicians of Philadelphia (University of Pennsylvania) in 1824. 
There, in the afterglow of such leading medico-legalists as Benjamin 

28. On Geneva Medical College at this time, see William F. Norwood, Medical 
Education in the United States before the Civil War (Philadelphia, Pa.: University of 
Pennsylvania Press, 1944), pp. 155-159, 164, and 411-412. 

29. "Accusation of Mal-practice," Boston Medical and Surgical Journal, 1844, 
31:123. 

30. This case, Smith v. Goodyear and Hyde, is developed at length by De Ville, 
Medical Malpractice, pp. 281—302, and may easily be tracked in detail through the 
medical journals and regional newspapers of the period. 

31. De Ville, Medical Malpractice, pp. 200-203 and 277; Frank H. Hamilton, 
Fracture Tables (Buffalo, N.Y., 1853); and James H. Cassedy, American Medicine 
and Statistical Thinking, 1800-1860 (Cambridge, Mass.: Harvard University Press, 
1984), pp. 87-88. 



14 



James C. Mohr 



Rush, Charles Caldwell, and Thomas Cooper, and under the direct 
influence of Robert Eglesfeld Griffith, Webster wrote his disserta- 
tion on medical jurisprudence. The thesis summarized the field as 
it then appeared to an enthusiastic student. Webster thought medical 
jurisprudence in 1824 had "assumed a more imposing aspect" than 
it ever possessed before and was becoming recognized as an "indis- 
pensable" element of future professional training in the United 
States. 32 

For 25 years, through 1849, Webster maintained his commit- 
ment to medical jurisprudence as Beck and Griffith had conceived 
of it. He taught the subject in Philadelphia through 1835 and in 
New York City from 1835 through 1842. In the latter city he 
delivered a course of lectures on medical jurisprudence to the Bar 
of New York. In 1842 Webster went to Geneva as professor of 
anatomy and medical jurisprudence, and when asked to deliver the 
ceremonial introductory lecture shortly thereafter, he had, in his 
own words, taken "the occasion to endeavor to impress upon the 
minds of a former class, my sense of the deep importance of a clear 
and accurate knowledge of the principles of Medical Jurisprudence 
to the practising physician and surgeon." 33 

In the spring of 1850 Webster was again asked to deliver the 
ceremonial lecture that opened each term. And as he had in the 
past, Webster again took up the subject of medical jurisprudence. 
But this time, exactly at mid-century, his tone shifted dramatically. 
Until he came to Geneva, Webster stated, he had never encountered 
a malpractice case, though he had frequently been an expert witness 
in medical cases of almost every other sort. In recent years, however, 
the subject of malpractice had come to overshadow all other aspects 
of legal medicine. As a result, the optimism and excitement that 
Webster himself had enjoyed as a student when he contemplated 
the possibilities of combining medicine and law in the public interest 
had come to be replaced in the minds of his Geneva students 25 
years later by fear and misgiving. Responsible teachers of medical 
jurisprudence in western New York in 1850 could no longer afford 
noble dreams, Webster suggested to his students; the time had come 



32. James Webster, Jr., Medical Jurisprudence (Philadelphia, Pa., M.D. thesis, 
submitted 8 April 1824; now bound with Miscellaneous Theses, College of Physi- 
cians of Philadelphia, Vol. 1), p. 2. 

33. James Webster, Introductory to the Course on Anatomy, in Geneva Medical 
College, March 7th, 1850 (Geneva, N.Y.: E. Van Volkenburgh, 1850), p. 6 (now in 
the pamphlet collection, College of Physicians of Philadelphia). 



Emergence of Medical Malpractice 15 



to face up to the fact that medical jurisprudence courses had to 
address "the darker side of your professional prospects." 

Once a champion of active involvement, Webster now felt 
obliged to suggest "a remedy" to avoid "the attacks of the unprinci- 
pled, . . . escape persecution, and protect yourselves from the as- 
saults of the unworthy upon your professional reputations, as well 
as your peace and comfort, to say nothing of your property, if you 
should be so fortunate to accumulate any." 34 His advice was to 
refuse fracture cases among the poor. If the graduates proved unable 
to "sacrifice . . . the best feelings of your nature," and took such 
cases anyway, counselled Webster, at least make certain that "judi- 
cious witnesses" wrote down everything you did and kept indepen- 
dent ongoing records of the case. 35 What a far cry from the idealistic 
hopes, humane sentiments, and cooperative assumptions that in- 
fused the Elements a quarter of a century earlier and drew Webster 
himself to the field. 

What happened at Geneva exactly at mid-century was repeated 
in less dramatic ways throughout the United States in the decades 
that followed. Legal medicine became so intertwined with the ques- 
tion of medical malpractice that students and professors alike began 
to emphasize not the positive interactions envisioned in previous 
decades, but practical tactics to minimize the involvement of physi- 
cians in legal processes. Practitioners grew less tolerant of idealistic 
exhortation about the ways in which law and medicine ought to 
cooperate and more demanding of tactical advice about staying out 
of legal trouble. 

Two books that appeared in 1860 neatly epitomized the transi- 
tion. The first was the 11th edition of the Becks' Elements. Prepared 
by friends and colleagues of the late Beck brothers, the 11th edition 
contained a good deal of new material added by a number of 
experts in their particular areas of interest. 36 Edward Hartshorne, 
a distinguished scholar of medical jurisprudence himself and the 
American editor of several English texts on the subject, reviewed 
the new 11th edition for the American journal of Medical Science. 
He knew "no single work on a subject relating to medical science 



34. Webster, Introductory to the Course on Anatomy, pp. 6—7. 

35. Webster, Introductory to the Course on Anatomy, pp. 6 and 12. 

36. Chandler Robbins Gilman, who was professor of medical jurisprudence at 
the College of Physicians and Surgeons of New York, took the editorial lead in the 
preparation of the 11th edition, but at least 15 other medical scientists also contrib- 
uted to the effort. 



16 



James C. Mohr 



... so full of varied and absorbing interest to every class of readers," 
as the Elements. Moreover, the book remained "the most compre- 
hensive and complete upon its subject in the English language." But 
Hartshorne stressed twice in his relatively short discussion the tell- 
ing fact that the Elements had become essentially "a work of refer- 
ence." Hartshorne expressed the hope that future teams of editors 
and revisers would keep the Elements up-to-date and in print as a 
reference tool, primarily because the material it contained should 
be kept "within the reach of medical jurists." 37 

Hartshorne's observation that the 11th edition of the Becks' 
book was useful principally to "medical jurists" was in a subtle way 
quite damning; by implication the book was no longer central to 
the concerns of most ordinary practitioners. In fact, there would be 
only one more edition, the 12th, published in 1863, and it was 
essentially a reprint of the 1860 edition with a couple of small 
additions. From a virtual manifesto in 1823, the Elements by 1860 
seemed ponderous, old-fashioned, and somewhat marginal. In its 
place appeared a book with an altogether different tone: John J. 
Elwell's A Medico-Legal Treatise on Malpractice, Medical Evi- 
dence, and Insanity, Comprising the Elements of Medical 
Jurisprudence. 

Citing the surge of malpractice actions in the previous 15 years 
and stressing the fact that the malpractice crisis seemed to be spread- 
ing, not receding, Elwell wanted "to strip the subject [of medical 
jurisprudence generally] of all . . . profitless details" and "specula- 
tive themes" in order "to furnish the medical man that necessary 
information respecting his legal responsibility as a practitioner and 
witness which he has been hitherto unable to obtain, except by the 
general study of law." 38 If a previous generation of doctors had 
needed and responded to Beck's idealistic and erudite suggestions 
about interesting ways to get involved with the law, the nation's 
physicians now needed something much more pressing: knowledge 
to "protect themselves from unjust prosecutions while in the legiti- 
mate pursuit of their calling." Some medical societies had been 



37. Edward Hartshorne, "Art. XXXII," American Journal of Medical Science, 
1860,39:211-212. 

38. John J. Elwell, A Medico-Legal Treatise on Malpractice and Medical Evi- 
dence Comprising the Elements of Medical Jurisprudence (New York: Voorhis &C 
Co., 1860), "Preface," pp. 7-9, 10, and 12. 

39. Stephen Smith, "Art. XV," American Journal of Medical Science, 1860, 
40:155. 



Emergence of Medical Malpractice 17 



calling openly for such a study during the 1850s; and, using 
excerpts from recent malpractice cases, that was exactly what Elwell 
tried to give his readers. A Medico-Legal Treatise on Malpractice, 
the first serious study of its sort in the United States, thus became 
the first book in what would eventually be a long tradition of 
defensive medical jurisprudence. 

Numerous review essays and an outpouring of testimonials 
demonstrated that Elwell had touched a sensitive nerve. Walter 
Channing, who had taught medical jurisprudence in the tradition 
of Rush and Beck at Harvard before malpractice provoked his 
disillusionment with the field, now wrote Elwell to congratulate 
him on "this important addition to our professional literature" and 
prepared a pamphlet to alert other physicians to the excellence 
and significance of ElwelPs volume. 41 John Ordronaux, who would 
shortly rise to the top ranks of New York's medico-legal experts, 
hailed Elwell's A Medico-Legal Treatise on Malpractice as an out- 
standing work that met the most "pressing deficiency in any depart- 
ment of medico-legal literature." 42 The aging Robley Dunglison 
recommended the book to his class at Jefferson Medical College. 43 
Dozens of others, including lawyers and judges, joined the chorus. 
The Boston Medical and Surgical Journal, the Cleveland Medical 
Gazette, the Cincinnati Lancet and Observer, the Cincinnati Medi- 
cal and Surgical News, the Chicago Medical Journal, the New York 
Journal of Medicine, the American Medical Gazette, the American 
Journal of Pharmacy, the Boston Law Reporter, and a surprisingly 
large number of regular daily newspapers, including the New York 
Herald and the New York Times praised the important professional 
job Elwell had performed. 44 

And even as the grand old Elements began to fade from view, 
the standing of Elwell's A Medico-Legal Treatise on Malpractice 
soared. A second edition was issued in 1866, a revised third in 

40. See, for example, the resolution of the Medical Association of Southern 
Central New York, reprinted and endorsed in Boston Medical and Surgical Journal, 
5 July 1855, 52:444. 

41. Walter Channing to John J. Elwell, 16 May 1860, reprinted in the front 
matter of the 1866 edition of Elwell's A Medico-Legal Treatise on Malpractice. For 
Channing's long, favorable review of the book see Boston Medical and Surgical 
Journal, 1860, 62:233-241, 259-265, and 300-307. 

42. John Ordronaux to John J. Elwell, 8 March 1860, reprinted in the front 
matter of the 1866 edition of Elwell's A Medico-Legal Treatise on Malpractice. 

43. Robley Dunglison to John J. Elwell, n.d., reprinted in ibid. 

44. Excerpts from these reviews are reprinted in the 1866 edition of Elwell's A 
Medico-Legal Treatise on Malpractice. 



18 



James C. Mohr 



1871, and a revised fourth in 1881. Discussions of ElwelPs A Medi- 
co-Legal Treatise on Malpractice confirmed the existence of the 
growing gulf between law and medicine, a gulf that the early cham- 
pions of medical jurisprudence had either not foreseen or tried to 
bridge. The New York Medical Press, for example, thought ElwelPs 
book signalled an important new departure in the literature on law 
and medicine because it faced straightforwardly the reality that 
now presented itself. Law and medicine had evolved into mutually 
incompatible professions. Consequently, "It is . . . necessary that [a 
doctor] knows what he should say and do in a contingency which 
may happen, and unexpectedly, any time," especially in "civil suits 
for malpractice." Unfortunately, "none of the medical jurispru- 
dences [i.e., previous works on the subject] have been at all suffi- 
ciently practical" in such matters, and the medical profession, as a 
result, was suffering. Elwell helped doctors bridge the "chasm" 
between the professions, rather than fall into it. The Press consid- 
ered Elwell's material valuable for lawyers, but absolutely "para- 
mount to our medical brethren." 45 

Even those few experts in medical jurisprudence who disliked 
Elwell's approach to the subject acknowledged the fact that he and 
his book signalled something of a new era for the field. Stephen 
Smith, a medical activist, public health crusader, and politically- 
minded professional who embraced broad views of professional 
interaction and became influential in New York City health policy 
and New York State medical reform after the Civil War, was among 
Elwell's few unenthusiastic reviewers. Smith may simply have been 
disappointed that Elwell got there first, however, for Smith had been 
at work on a similar volume himself. 46 Nonetheless, Smith ended 
his long analytical discussion of A Medico-Legal Treatise on Mal- 
practice with a begrudging recognition that Elwell had "done much 
to establish the principles which are to lead to the development of 
malpractice in medicine as an important branch of medical jurispru- 
dence." 47 Smith could hardly have known how prescient that was. 



45. "Notice" of Elwell's A Medico-Legal Treatise on Malpractice and Medical 
Evidence: Comprising the Elements of Medical Jurisprudence, New York Medical 
Press, 1860, 3:141-142. 

46. Boston Medical and Surgical Journal, 5 July 1855, 52:444. 

47. For Smith's activities as a health reformer, see James C. Mohr, The Radical 
Republicans and Reform in New York during Reconstruction (Ithaca, N.Y.: Cornell 
University Press, 1973), pp. 61-85. Smith's review of Elwell's A Medico-Legal Trea- 
tise on Malpractice appeared as Stephen Smith, "Art. XV," American Journal of 
Medical Science, 1860, 40:153-166. The quote is from p. 166. 



Emergence of Medical Malpractice 19 



Elwell's work was quickly joined in the medico-legal market- 
place by nationally important and well-received studies that ac- 
cepted most of his priorities and tried to improve upon his 
understanding of malpractice. The best of them was Ordronaux's 
own book, The Jurisprudence of Medicine in its Relation to the 
Law of Contracts, Torts and Evidence, which appeared in 1869. 
Like Elwell, Ordronaux held formal degrees both in law and in 
medicine. He had graduated from Harvard Law School in 1852, 
then studied medicine later in the decade with the specific purpose 
of taking up medical jurisprudence as a specialty. He was appointed 
to a chair in the subject at Columbia Law School in 1861 and 
continued to teach there until the end of the century. Also like 
Elwell, Ordronaux projected a cautious and defensive attitude to- 
ward his own specialty. 48 Milo McClelland's popular Civil Malprac- 
tice, which appeared in 1873, further emphasized the fact that the 
dangers of litigation had become the central concern of medical 
jurisprudence. 49 

By the end of the nineteenth century, medico-legal experts were 
lionized in the medical profession not for their contributions to 
justice in the American republic, but for their ability to defend 
physicians against charges of malpractice. The well-known Na- 
tional Cyclopaedia of American Biography specifically recognized 
in its index only four individuals prominent during the late nine- 
teenth and early twentieth centuries for their efforts in the field of 
medical jurisprudence. One was Ordronaux (1830-1908). Another 
was James T. Lewis (1865-1935), who engineered a merger of New 
York's two rival medical societies in the early 1920s and "defended 
many of the most prominent medical men in the state and argued 
cases before many courts. The successful defense of over one thou- 
sand medical malpractice actions earned him general recognition as 
a man with a unique combination of medical and legal talent.' 00 

48. On Ordronaux see National Cyclopaedia of American Biography, 
72:331—332; Dictionary of American Biography, 7:50—52. 

49. Milo McClelland, Civil Malpractice (New York, 1873). This was a reprint 
for national publication of a report McClelland had done on malpractice for the 
Chicago Medical Society. 

50. National Cyclopaedia of American Biography, 27:352. After his retirement 
in 1924, interestingly enough, Lewis switched sides and took "numerous malpractice 
actions, this time on behalf of the plaintiff." The other two people singled out for 
work in the field of medical jurisprudence were James W. Putnam, the AMA president 
and neurologist who was considered among the nation's leading authorities on the 
forensic aspects of insanity, and William C. Woodward, the Washington, D.C., 
sanitation reformer who also taught medical jurisprudence for many years at George- 
town and other universities. 



20 



James C. Mohr 



The small number of people whose chief fame resulted from medical 
jurisprudence was striking enough in itself, but even more signifi- 
cant is the fact that half the tiny group, Ordronaux as a theorist 
and Lewis as a practitioner, owed much of their fame as medico- 
legal experts to their involvement in the question of malpractice. 

The great wave of malpractice suits never really ebbed. If any- 
thing, it increased both in absolute numbers and in rates relative to 
population. Initial panic abated somewhat as physicians moved to 
counter the specific accusations associated with orthopedic surgery, 
largely through statistical analyses of reasonable success rates. Phy- 
sicians also began to experiment with various self-protective mecha- 
nisms, including medical society legal defense funds, medical society 
pledges of mutual defense, and the first malpractice insurance 
schemes. 51 In that context, the rise of malpractice litigation at mid- 
century certainly helped accelerate cooperation and consolidation 
among American physicians. 52 

It would be ahistorical, though certainly tempting in light of 
twentieth-century developments, to overemphasize the impact of 
the nation's first malpractice crisis on the history of medical juris- 
prudence in the nineteenth century. Instead, that initial malpractice 
crisis must be seen in and considered part of a much larger context 
of mounting problems for physicians involved with legal processes 
in the United States between 1840 and 1860. But there is no 
question that the rise of medical malpractice dealt legal medicine a 
heavy blow, a blow that still staggers American professionals today; 



51. De Ville, Medical Malpractice, pp. 373-378 and 399-402. The Medical 
and Surgical Society of Baltimore was a good example of a local medical association 
that pledged its members to mutual defense in court: Maryland Medical Journal, 
1879, 6(2):135-136. An excellent example of a local medical society responding 
effectively to a malpractice threat in San Francisco in 1885 is chronicled in Neil 
Larry Shumsky, Paul Knox, and James Bohland, " 'All For One and One For All': 
Medical Professionalization in San Francisco, 1850-1900," unpublished paper 
kindly supplied by the authors. 

52. The reverse, according to Paul Starr, was also true by 1900: consolidation 
helped stamp out some of the most professionally damaging aspects of the early 
malpractice crisis. Paul Starr, The Social Transformation of American Medicine: The 
Rise of a Sovereign Profession and the Making of a Vast Industry (New York: Basic 
Books, 1982), p. 111. 

53. The author is working on a full study of medical jurisprudence in the United 
States through 1900, which will be published in 1993 by Oxford University Press. 
This article is taken from a chapter of that book. 



Emergence of Medical Malpractice 21 



and there is no question that it had a profound impact upon the 
long-term development of law and medicine in the United States. 



Department of History, 

University of Maryland, Baltimore County 

5401 Wilkins Avenue 

Baltimore, MD 21228-5398 



Revolt Against Quarantine: Community 
Responses to the 1916 Polio Epidemic, 
Oyster Bay, New York 1 

GUENTER B. RISSE 

The attempts at quarantine practiced the past summer were so 
incomplete, especially in many country towns, so lacking in 
uniformity, so changeable and erratic, that the public lost con- 
fidence in them. Hence the cooperation of the public was lost 
.... In this the local boards were more or less influenced in 
their action by hysterical groups of citizens and lay committees 
more governed by panic than reason. 2 

The establishment and enforcement of public health regulations 
designed to cope with epidemic disease has created tensions and 
conflicts since the Renaissance. Charged with the enforcement of 
cleaning up campaigns and quarantines, officials are pitted against a 
fearful and suspicious public. Instead of acquiescence, public health 
regulations have often elicited strong resistance from the very people 
that they are designed to protect. As historians interested in health 
matters began to wrestle with the issues of authority, power, and 
control, public health developments came to be seen as the result 
of complex negotiations and struggles involving all parties in soci- 
ety. 3 This has been recently demonstrated by the spectrum of re- 
sponses to AIDS, a phenomenon that stimulates the examination of 
past epidemics. 4 



1. This paper constitutes an expanded version of the Samuel X Radbill Lecture 
of the Section on Medical History given at the College of Physicians of Philadelphia 
on 17 October 1990. I would like to express my appreciation to all of the persons 
who helped me with my research, especially Richard A. Winsche at the Nassau 
County Museum Reference Library, Anthony M. Brescia from the Nassau Commu- 
nity College, Dorothy Moore at the Oyster Bay-East Norwich Public Library, and 
William P. Gorman at the New York State Archives for their kind assistance in 
locating sources for this study. Both Ruth Schwartz Cowan and Naomi Rogers 
provided valuable suggestions. Special thanks go to my assistants Rebecca Ratcliff 
and Andrea Richardson. 

2. E. H. Bartley, "Clinical Experiences with Poliomyelitis," Long Island Medical 
Journal, 1916, 10:459. 

3. Charles E. Rosenberg, "Disease in History: Frames and Framers," Milbank 
Quarterly, 1989, 67(supplement 1):1-15. 

4. For an overview, consult the various contributions in Elizabeth Fee and Daniel 
Fox, eds., AIDS: The Burdens of History (Berkeley, Calif.: University of California 
Press, 1988). 

23 

Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 23-50 
© 1992 by The College of Physicians of Philadelphia. 



24 



GUENTER B. RlSSE 



This paper chronicles and analyzes events surrounding the 
1916 epidemic of polio in the village and township of Oyster Bay, 
New York, which culminated in a little publicized citizens' revolt 
against contemporary public health measures. The town's residents 
paid dearly for their contact with the disease. In proportion to its 
population, the township recorded one of the highest incidences of 
polio in the entire nation. 5 To understand better the multiple forces 
shaping public policy, an attempt has been made to place this epi- 
sode within its unique cultural, scientific, and economic contexts. 
The emergence of this frightful "new" disease of infantile paralysis 
in the early twentieth century created horror and panic. Its predilec- 
tion for young children caused families to pack up and flee from 
affected cities and towns to escape the scourge. 6 As with AIDS in 
the early years after its appearance, the medical profession was 
divided about the causes of polio, and about its transmission, treat- 
ment, and prevention. While this study represents the examination 
of a single epidemic in a specific geographical location, it exposes 
some of the dilemmas faced in America by the new, bacteriolog- 
ically-informed public health. 

The Coming of Polio 

By the early 1900s, Nassau County on Long Island was booming, 
especially the North Shore communities recently linked to New 
York City by railroad and steamship. While large estates and farms 
continued to give the "Gold Coast" its traditional prestige, cottages, 
boarding houses, and hotels now promised a host of recreational 
opportunities for the average weary city dweller. 7 Among the more 

5. "It has been the worst epidemic of any kind that has ever afflicted Long 
Island." F. Overton, "The Control of Poliomyelitis on Long Island," Long Island 
Medical Journal, 1916, 20:445. See also John R. Paul, "The Epidemic of 1916," in 
A History of Poliomyelitis (New Haven, Conn.: Yale University Press, 1971), chap. 
15, pp. 148-160. For a contemporary account, see Haven Emerson, "The Recent 
Epidemic of Infantile Paralysis," Bulletin of the Johns Hopkins Hospital, 1917, 
28:131—136 and his more extensive A Monograph on the Epidemic of Poliomyelitis 
(Infantile Paralysis) in New York City in 1916 (New York: New York Health Depart- 
ment, 1917). 

6. For a similar study of another community, see Stuart S. Galishoff, "Newark 
and the Great Polio Epidemic of 1916," New Jersey History, 1976, 94:101-111. 
For further work on polio in New York, Philadelphia, and Newark in a broader 
context, see Naomi Rogers, Dirt and Disease: Polio Before F.D.R. (New Brunswick, 
N.J.: Rutgers University Press, 1992), forthcoming. 

7. For background, consult Edward J. Smits, Nassau, Suburbia USA (Garden 
City, N.Y.: Doubleday, 1974). 



Revolt Against Quarantine 



25 




Oyster Bay Dock, Oyster Bay, L 



Figure 1. 

Courtesy of the Long Island Studies Institute, Hofstra University. 



prominent resorts was the village of Oyster Bay, seat of the summer 
White House during the presidency of Theodore Roosevelt, who 
spent time at his retreat on Sagamore Hill. Tourism, and, for several 
years, the presence of presidential staff members and numerous 
newspaper reporters 8 more than compensated for the marked de- 
cline of Oyster Bay's prominence as a Long Island shellfishery (see 
Fig. 1). Its rich oyster and clam beds had been progressively contam- 



8. An editorial in the Democratic paper the Oyster Bay Guardian (hereafter 
O.B.G.) of 28 April 1916 questioned the value of Roosevelt's periodic utterances to 
the press, insisting that the ex-Republican president was now just a plain citizen 
"whose dictum must not be taken as the law of reason or as absolute." 



26 



GUENTER B. RlSSE 



inated by the steady influx of untreated sewage into the bay. 9 The 
village acquired some notoriety when the Irish cook, later known 
as "Typhoid Mary," came to the attention of epidemiologists after 
six members of a single household contracted the disease in 1906. 10 

A health survey conducted in Oyster Bay during early 1916 
identified the lack of a proper sewer system as a major sanitary 
problem. Most privy vaults and sewers from the larger estates emp- 
tied directly into the bay. This remained a sensitive issue, since the 
year-round population of close to five thousand people was reluc- 
tant to approve more taxes for expenditures involving public health. 
An earlier outbreak of diphtheria at neighboring Glen Cove had 
prompted state health officials to screen suspected carriers and iso- 
late some of them; such measures were characterized by the local 
press as part of an unnecessary health scare deemed "adverse to the 
welfare of townspeople." 11 A climate of suspicion, and disregard 
of all sanitary advice thwarted the activities of the township's health 
officer, William J. Burns, a Bellevue graduate and prominent prac- 
titioner residing at Sea Cliff. 12 Burns seemed powerless to enforce 
local health ordinances, and his demands that violators be prose- 
cuted fell on deaf ears at meetings of the town council. 13 

After cases of diphtheria were reported in mid- April 1916 
among Polish and Italian immigrants in a new village, Forest Park, 
the authorities continued to express their reluctance to spend addi- 
tional funds for hiring quarantine watchmen. This would have 
meant higher taxes, perhaps affordable by wealthy summer visitors 
but disagreeable to Oyster Bay's permanent residents of modest 
means. 14 Late in May, Burns completed his presentation of the 
sanitary survey, which pointed out that the very survival of the 

9. See the editorial in O.B.G., 26 May 1916. Oyster Bay's main source of 
revenue, hundreds of thousands of bushels of oysters, was being contaminated by 
the sewage. The author commenting on these conditions suggested that it was time 
for action. "Where is the Moses who will lead the hosts out of the wilderness?" he 
asked. 

10. G. A. Soper," The Work of a Chronic Typhoid Germ Distributor," JAMA, 
1907, 48:2019-2022. 

11. O.B.G., 3 December 1915. 

12. For biographical information on Burns, see William S. Pelletreau, A History 
of Long Island (New York: Lewis, 1903), 3 :98-99. 

13. "We have not as yet, unfortunately, reached the stage where we release our 
money pro bono publico unless we see the greatest benefit for ourselves." O.B.G., 
31 December 1915. 

14. An editorial in O.B.G., 14 January 1916, titled "The Health Scare," had 
already seriously questioned the reason for a quarantine and the expenses associated 
with it. 



Revolt Against Quarantine 



27 



village and its oysters was at stake if pollution continued. The report 
was turned over to Justice Duvall, one of the town council members, 
but there was no further discussion concerning the sewer. By early 
June, the local press also strongly opposed a plan to establish a 
county tuberculosis sanitarium in Oyster Bay on the grounds that 
it was not needed. 15 

Less than a week later, on 6 June, the first victims of polio were 
reported from a densely populated section of Brooklyn housing 
Italian immigrants. 16 The disease had been rare before 1907, when 
it killed more than 2,500 persons in Brooklyn, but thereafter epi- 
demics began to break out in many parts of the United States with 
greater frequency each summer. Between 1910 and 1915, thirty 
thousand cases of polio were reported throughout the country, 
causing about five thousand deaths. 1 The new outbreak prompted 
health officer Burns in Oyster Bay to press again for the prosecution 
of violators of local sanitary ordinances. This was appropriate, 
since health authorities responding to polio in New York City had 
adopted a number of measures historically employed to deal with 
epidemic disease: cleaning up the environment and the isolation of 
suspected cases. 18 Focused on dirt and dust, the epidemiological 
model underlying these measures was based on disease-bringing 
miasma theories. It also postulated that the biting stable fly was the 
necessary carrier of the contagion, and thus explained the apparent 
random spread of polio across both class and geographical bound- 
aries. 19 Under the leadership of Haven Emerson, a former prac- 

15. O.B.G., 2 June 1916. "Absolute needlessness" was the newspaper's verdict. 

16. For an overview of the public reaction in this epidemic, see Guenter B. 
Risse, "Epidemic and History: Ecological Perspectives and Social Responses," in Fee 
and Fox, eds., AIDS: The Burdens of History, pp. 33-66, and Rogers, Dirt and 
Disease. 

17. Saul Benison,"The Enigma of Poliomyelitis: 1910," in Freedom and Reform: 
Essays in Honor of Henry Steele Commager, ed. H. M. Hvman and L. W. Lew 
(New York: Harper & Row, 1967), pp. 228-254. 

18. A letter to this effect was received from the New York State Health Depart- 
ment. See Minutes, Oyster Bay town council meeting, 19 June 1916, Oyster Bay 
Town Hall, Long Island, New York. See also Haven Emerson, "Some Practical 
Considerations in the Administrative Control of Epidemic Poliomyelitis," American 
Journal of Medical Science, 1917, 753:160—178, and by the same author "The 
Responsibilities of the Department of Health of the City of New York," Long Island 
Medical Journal, 1916, 70:261-266. 

19. This hypothesis was based on findings from a number of animal experi- 
ments. Consult Naomi Rogers, "Dirt, Flies, and Immigrants: Explaining the Epidemi- 
ology of Poliomyelitis, 1900-1916," Journal of the History of Medicine, 1989, 
44:489-505. Further details are in Naomi Rogers, "Screen the Baby, Swat the Fly: 
Polio in the Northeastern United States, 1916" (Ph.D. dissertation, University of 



28 



GUENTER B. RlSSE 



titioner familiar with cholera, New York City's health department 
commenced a vigorous cleaning campaign, daily dumping up to 
four million gallons of water on the streets. 20 

Such a traditional public health approach, based on outdated 
theories of disease, exposed the persistent gulf between the imple- 
mentation of health policies and the new bacteriological revolution. 
Since 1909, bacteriologists working within the new scientific para- 
digm had postulated that poliomyelitis was caused by a submicro- 
scopic microorganism transmitted by droplets in the air. Organisms 
entered the human body through the nose, travelled along the olfac- 
tory nerves to the brain and eventually entered the spinal cord. This 
hypothesis was primarily defended by Simon Flexner, the director 
of the Rockefeller Institute of Medical Research in New York, on 
the basis of experimental work performed on monkeys that were 
serially infected. 21 While seeing the etiology of polio similarly in 
bacteriological terms, clinicians were concerned about the discrep- 
ancies between the clinical picture and Flexner's model. Thus, they 
sought to expand the pathological model in accordance with their 
own observations. The mode of infection appeared complex. Most 
adults displayed specific immunities to the disease that suggested 
widespread contagion, while there were many healthy carriers 
alongside numerous victims who suffered mild, non-paralytic 
forms. 22 

The sanitation debate in Oyster Bay continued in view of the 
polio epidemic now raging in New York City. In June, the local 
newspaper complained that the expanding population was "largely 
composed of people who have been unused to paying regard to 
sanitary methods of any kind" — a reference to immigrants from 
Southern and Eastern Europe. Burns was portrayed as "overzea- 
lous" in his demands for improved sanitation, and his efforts were 
distrusted and linked to previous demands for a salary increase. 23 



Pennsylvania, 1986), and her forthcoming book. For a contemporary source, see W. 
H. Frost, "Poliomyelitis (Infantile Paralysis). What is Known of its Causes and 
Modes of Transmission," Public Health Reports, 1916, 31 : 1 8 1 7— 1833. 

20. New York Times, 10 July 1916. 

21. Saul Benison, "Speculation and Experimentation in Early Poliomyelitis Re- 
search," Clio Medica, 1975, 10:1-22. 

22. Simon Flexner, "The Nature, Manner of Conveyance, and Means of Preven- 
tion of Infantile Paralysis," JAMA, 1916, 67:279-283. For a near contemporary 
view of this institution, see H. T. Wade, "The Rockefeller Institute for Medical 
Research," The American Review of Reviews, 1909, 39:183-191. 

23. See O.B.G., 30 June 1916. Burns was paid $166.66 per month. 



Revolt Against Quarantine 



29 



In view of polio's presumed spread by contact with victims, conva- 
lescents, and carriers, the New York State board of health requested 
that local officials institute a system of immediate reporting and 
prompt isolation. This appeal was made just as an exodus of parents 
and their children from New York City into the surrounding villages 
and towns began. While some families were merely beginning their 
customary summer vacations, others left the city in haste to escape 
the epidemic and a possible quarantine. Fearful arrivals in Long 
Island encountered high rents for rooms in lodges, hotels, cottages, 
and boarding houses. Burns responded by selecting a building in 
the Orchard neighborhood of Glen Cove to function as a possible 
quarantine hospital. 

On 7 July, the first official case of polio was reported from 
Glen Cove in the Oyster Bay township. 24 Prior to the onset of 
symptoms, the small girl had visited Sea Cliff. This prompted the 
local health board there to demand that owners of rental premises 
report all newcomers to the police upon their arrival, so that nurses 
could periodically visit families with children and report those sus- 
pected of suffering from polio to the health authorities. New arriv- 
als were generally visited every other day for at least 10 days, with 
all suspicious cases reported to the health officer. 25 The perceived 
danger became even greater as four additional children, three of 
them also residing in Glen Cove, were reported with polio on 10 
and 12 July. Three of the victims were Italian, the other was Polish. 

After a "more or less acrimonious" discussion on 10 July, the 
Oyster Bay town council adopted a resolution forbidding all chil- 
dren under the age of 16 to assemble in public places, including 
camps, picnics, theaters, and Sunday schools. Burns's request at the 
meeting to hire additional nurses, however, was tabled amid criti- 
cism from the presiding supervisor, James H. Cocks. Debate began 
concerning the health officer's demand to outfit a quarantine hospi- 



24. This information was acquired from the actual reporting cards signed by 
health officer Burns and obtained from the New York State Archives, Albany, New 
York. The data does not contain death certificates, thus failing to reveal the true 
mortality rate. There are slight discrepancies between the statistics obtained from 
the cards and the information reported in the contemporary Public Health Reports. 
All statistical statements made throughout the paper, however, are based on the 
reporting cards. 

25. See, for example, minutes of 17 July 1916 meeting in Sea Cliff of the local 
board of health. Between 9-16 July, two nurses examined 219 children for a total 
of 519 examinations, but no cases of polio were found. This material was provided 
by Anthony M. Brescia from the village archives. 



30 



GUENTER B. RlSSE 



tal; others were in favor of allowing all suspected polio victims to 
remain in their homes. 26 Burns, in fact, had already removed the 
first polio suspects to the "Orchard." For the duration of the polio 
epidemic, Burns and Cocks remained at'odds about all public health 
measures imposed by the state. Cocks repeatedly questioned the 
scientific basis for the quarantine regulations arguing that physicians 
seemed divided about the cause and spread of polio. 

Matters became more complicated after 14 July, when New 
York City's health department began issuing health certificates to 
travelers, especially children, who submitted to a medical examina- 
tion or could prove that they lived in disease-free residences. New 
York City's Association for Improving Conditions of the Poor sug- 
gested that "if the kiddies are not in the county or at shore, get 
them there if you can," and towns such as Oyster Bay braced them- 
selves for the onslaught of city refugees brandishing certificates. 27 
At a board meeting a week later, Burns reported 16 cases of polio 
in the township, a third of those afflicted were Italian; one resided 
in the village of Oyster Bay. Five deaths resulted. One additional 
case, a two-year-old Polish boy, was transferred to the isolation 
facility in Glen Cove. At one point, Burns accused Cocks of being 
a carrier since the supervisor had provided a car ride to a child later 
detained and suspected of having the disease. 

Such revelations prompted the town council to approve a flurry 
of measures including a renewed ban on all visitors without health 
certificates issued at the point of embarkation, and a two-week 
quarantine for all children under the age of 16 living in the township 
including returning residents (see Fig. 2). Inspectors were posted at 
railroad stations in Hicksville, Glen Cove, and Oyster Bay to enforce 
these measures. Burns expressed reservations about the implementa- 
tion of local "house arrests" or home quarantine of children given 
the conditions of extreme crowding in a number of tenements near 
the railroad station. Burns was severely criticized for failing to sign 
50 official complaints against sanitation violators so that they could 
be prosecuted. 8 



26. Minutes, Oyster Bay town council meeting, 10 July 1916. This documenta- 
tion is available at the Oyster Bay Town Hall. 

27. Details about the quarantine around New York City can be found in Survey, 
29 July and 5 August 1916. Within one week, more than five thousand health 
certificates were issued by the New York City authorities. 

28. Minutes, Oyster Bay town council meeting, 21 July 1916. See also O.B.G., 
21 July 1916. 



Revolt Against Quarantine 31 



BAY. NAHHAl' COUNTY. N. Y„ KR1UAY. AI'UIW V \9\u. 



NOTICE OF QUARANTINE 

Children under 16 are hereby 

FORBIDDEN 

to come into the Town of Oyster Bay un- 
less accompanied by 

HEALTH CERTIFICATES 

from health authorities of their districts 

The town board of the town of Oyster Bay on 
Friday, July 21, I°I6, passed the following resolution] 

RESOLVED, By the Town Board of the Town of Oyster Bay, that until 
further order of this Board it shall be unlawful to bring into the town of 
Oyster Bay, any child or children under the age of sixteen years, unless the 
child or children shall produce and exhibit a certificate from the health au- 
thorities of the locality from whieh such children shall have come, certifying 
that such child or children are not infected with any communicable, conta- 
gious or infectious disease or diseases or has not come from any infected 
district or locality. 

RESOLVED, That this resolution take effect immediately and that the 
same be published and posted in the manner prescribed by the rules of this 
Board. 



Figure 2. Oyster Bay Guardian, 4 August 1916. 

Courtesy of the Long Island Studies Institute, Hofstra University. 

The Committee of 21 

Three days later, on 24 July, Oyster Bay's most famous resident, 
Theodore Roosevelt, appeared at a scheduled town council meeting 
accompanied by about one hundred prominent men and women 
from the village. In a fiery speech, Roosevelt forcefully denounced 
local health officials for negligence in pursuing the cleanup, and for 
allowing unsanitary conditions to prevail that could facilitate the 
spread of the new plague, infantile paralysis. "The sign posts to 



32 



GUENTER B. RlSSE 



Oyster Bay are tin cans and old newspapers," he declared. Under 
intense pressure, the council reacted.by approving the establishment 
of a citizens' Committee of 21, empowered to conduct its own 
sanitary campaign. Under the leadership of John F. Bermingham, a 
prominent resident, the group appointed a five-member subcommit- 
tee composed of local businessmen and physicians, charging them 
with the task of quickly making an updated sanitary survey of the 
village. Two Italians, Joseph De Pasquale and Joseph Diordano, 
were also appointed, ostensibly "in order that they be taught that 
cleanliness and order was for their good and was their cause as well 
as the cause of the Americans." 30 

The Committee of 21 wasted no time in making its own inspec- 
tions. Since Oyster Bay lacked a dump, garbage was piled high in 
nearly every backyard. Although most houses were supposed to 
have cesspools, waste water emptied into a brook running through 
the village. The stream was clogged at many points with debris and 
sewage emptied into the bay. The tenement houses across from the 
railroad station were inhabited by poor Italians and were especially 
filthy. Apprised of such conditions, the town council and local au- 
thorities promptly issued warrants for the arrest of 46 residents, 
including a notorious slumlord, and approved procedures to haul 
away garbage to a new dump site. 31 

At the same time, local police officers and a constable were to 
patrol the roads and railway stations day and night, turning back 
families with children who lacked the required health certificates. 
A committee was also formed to replace the "Orchard" facility and 
find a site to house all suspected polio victims. Although somewhat 
irregular in its genesis and a clear legal infringement of responsibili- 
ties normally assigned to health authorities, this sudden burst of 
sanitary activity was applauded. As the local newspaper explained, 
"fear gives place to enterprise. No one can care for the interests of 
your village so well as its own people." 32 

29. Minutes, Oyster Bay town council meeting, 24 July 1916. 

30. Ibid. An executive committee of three members made the final selections 
for the Committee of 21. Among them were I. F. Barnes, Archibald Wood, and 
Chester W. Cole from Oyster Bay who had already reported some polio patients. 
Mrs. Charles Tiffany was the only female member, offering to "stamp out disease." 

31. A list of violators was presented to an extraordinary meeting of the town 
board on 25 July. A number of tenement houses owned by Charles H. Jones, son of 
millionaire Oliver L. Jones, were "piled high with all sorts of refuse and dirt." On 
the inspecting team were two individuals previously accused by Burns as having 
violated sanitary laws. 

32. Editorial in O.B.G., 28 July 1916. 



Revolt Against Quarantine 



33 



Health officer Burns, meanwhile, received an anonymous death 
threat for continuing to send polio suspects to Glen Cove's tempo- 
rary quarantine facility located in the midst of a neighborhood 
populated by Italian immigrants. Anger and subsequent threats to 
burn down the facility resulted from the fact that a number of 
Italian children in Glen Cove and Oyster Bay had contracted the 
disease; this development was attributed to the proximity of the 
feared "Orchard." Frightened, owners of suitable accommodation 
alternatives in Glen Cove refused to allow their use as isolation 
facilities. A similar rejection came from the authorities in charge of 
Mercy Hospital at Hempstead. 33 Under attack by poor immigrants 
and wealthy summer residents, Burns found himself in a no-win 
situation: follow instructions issued by the state health authorities 
and risk further local antagonism, or stop reporting cases and face 
dismissal from the New York State Health Department. 

By 1 August, more than five hundred quarantine regulations 
were in effect in towns and villages bordering New York City. 
Many other towns hired additional guards and policemen who 
were posted at their borders. Equipped with red flags, they stopped 
virtually every automobile and made careful searches for concealed 
children. Even the Automobile Club of America was besieged with 
inquiries about road blocks, as traveling members demanded alter- 
nate routes to escape such impediments. Summer camps around 
New York City had susceptible populations of youngsters roaming 
inside and outside their compounds who posed further threats and 
raised concerns among parents and local health officials. Many 
camps were closed, and their visitors sent home. 34 

In the Oyster Bay township, meanwhile, the count of reported 
polio cases had risen to 27, with more than a third of the victims 
identified in Glen Cove. 35 A dozen had been taken to the isolation 
hospital, all but one of Italian or Polish ancestry. Yet, only half of 
these children exhibited clear signs of paralysis. More than 90 per- 



33. Minutes, Oyster Bay town council meeting, 31 July 1916. This fear of 
extending the range of the epidemic from isolated polio cases was the reason for a 
protest march in Glen Cove objecting to the hospitalization of afflicted children in 
the local community hospital and demanding the closing of the isolation ward. 
Personal communication, Ruth Schwartz Cowan. 

34. See daily reports in the New York Times during the months of July and 
August 1916. 

35. F. Overton, however, admitted that "we missed half of our cases during 
July," in "Control of Poliomyelitis," p. 447. 



34 



GUENTER B. RlSSE 



cent of those polio suspects remaining in isolation at their homes 
were listed as American citizens. 

The citizens' committee, now numbering 24, was authorized 
to conduct a cleanup campaign in Oyster Bay, and continue its 
inspections. Frequent meetings were held during which Roosevelt 
was identified as a "thought leader" whose suggestions were usually 
adopted without debate. 36 A fund-raising campaign was planned 
and a large number of letters were sent to villagers soliciting money 
for the local cleanup, the erection of a hospital, and the construction 
of a sewer. Although barely a week old, the group came under 
criticism by the permanent residents of Oyster Bay, because of its 
propensity to focus only on the "little fellows" with their backyard 
rubbish while ignoring the owners of larger country estates, who 
continued to dump their sewage into the bay with impunity. Ac- 
cording to the local newspaper this attitude was typical of the 
summer residents, who were seldom seen, but were prone to orga- 
nize themselves for their own self-interest. 37 

The well-heeled Oyster Bay committee focusing on waste dis- 
posal stood in stark contrast to a new Committee for the Suppres- 
sion of Infantile Paralysis established in the village of Glen Cove on 
6 August. This local citizens' group contained a number of perma- 
nent Italian and Polish residents who distributed information about 
polio in English, Italian, and Polish to the anxious population. 
Garbage cans were distributed free of charge, and quarantined 
families received replacement wages to compensate for loss of in- 
come. Five nurses were hired to carry out a house-to-house inspec- 
tion. 38 The incorporated village of Sea Cliff also continued to hold 
regular meetings of its own board of health, under the direction of 
Dr. Albert M. Bell. 39 

The succeeding two weeks witnessed the height of the polio 
epidemic in the Oyster Bay township, with an additional 41 re- 
ported cases. Only two of the new patients were Italian, eight were 



36. O.B.G., 4 August 1916. 

37. Ibid. 

38. The details were revealed in the East Norwich Enterprise, 2 September 
1916. 

39. Sea Cliff News, 5 August 1916. Albert M. Bell was the son of Charles W. 
Bell, the popular postmaster of the village. A graduate of Cornell University, Albert 
Bell had started to practice medicine in Sea Cliff in 1913. See Paul Bailey, ed. Eong 
Island: A History of Two Great Counties, Nassau and Suffolk, 3 vols. (New York: 
Lewis Historical Publishing, 1949), 3:200-201. 



Revolt Against Quarantine 



35 



listed as Polish. As one editorial in the Oyster Bay Guardian 
reported, "people are reduced to a hysterical state of mind because 
of the spread and the lack of knowledge to prevent it." 41 Even 
Roosevelt seemed quite apprehensive about the "paralysis plague," 
especially since his grandson Richard was spending the summer 
with him at Sagamore Hill. 42 

Concerned about the mounting polio toll in this part of Long 
Island, the State of New York created a new sanitary district in 
Nassau County with the help of voluntary subscriptions from the 
adjoining towns and villages. 43 Headquartered in Roslyn, the labo- 
ratory facility was placed under the supervision of Dr. George 
Draper and four assistants. Hailed as the best equipped man to 
combat this disease, Draper was already famous for his work at the 
Rockefeller Hospital linked to the prestigious Institute for Medical 
Research in New York City. He was unquestionably the most expert 
American physician regarding the clinical behavior of polio. 44 The 
State Department of Health also instituted a house-to-house sani- 
tary survey of the congested areas in all Nassau County villages 
affected by the epidemic. Inspectors were dispatched to investigate 
and report their findings to Albany. At the same time, new state 
regulations attempted to strengthen the compulsory reporting of 
cases, the mandatory disinfection of infected premises, and the re- 
moval of suspected polio victims to isolation hospitals. Henceforth 
no public funerals for victims of the disease were permitted. All 
violations were to carry misdemeanor charges. 45 

In Oyster Bay, supervisor Cocks reluctantly negotiated the use 
of new quarantine facilities at the Jones Institute in Hicksville, 



40. Similar peaks were reported for Greater New York although the epidemic 
was already declining in Brooklyn and Richmond. See C. H. Lavinder, "Status of 
Poliomyelitis in New York City," Public Health Reports, 1916, 31 : 2407-24 11 and 
Public Health Reports, 1916,31 :28 16-2820. 

41. O.B.G., 11 August 1916. 

42. See 21 August 1916 letter to Richard Derby in The Letters of Theodore 
Roosevelt, selected and ed. by Elting E. Morison (Cambridge, Mass.: Harvard Uni- 
versity Press, 1954), 8:1105-1106. 

43. Oyster Bay pledged the sum of $5,000 and immediately requested cash 
contributions of $25 and $100 from its citizens. Both Roosevelt and Bermingham 
contributed $25 each to the fund. 

44. George Draper, a graduate from the College of Physicians and Surgeons in 
New York, later wrote Acute Poliomyelitis (Philadelphia, Pa.: Blakiston, 1917), 
with a foreword by Simon Flexner. For more information see Paul, History of 
Poliomyelitis, chap. 16, pp. 161-166; and George W. Corner, A History of the 
Rockefeller Institute, 1901-1953 (New York: Rockefeller Institute Press, 1964). 

45. Minutes, Oyster Bay town council meeting, 14 August 1916. 



36 



GUENTER B. RlSSE 



because of strong pressure from the Glen Cove citizenry to abandon 
the now infamous "Orchard," 46 and a refusal by Sea Cliff authori- 
ties to allow the erection of a temporary structure in that village's 
central park. Two additional options emerged, as the Neighborhood 
Associations of nearby Locust Valley and Roslyn authorized the use 
of their own local hospital facilities. 47 The public remained opposed 
to isolation facilities, confused about their purpose. Were they true 
"pesthouses" reserved only for confirmed cases in need of medical 
attention or were they also observation clinics for individuals with 
suspicious symptomatology? 48 Since diagnosis of polio was difficult 
before paralytic symptoms developed, why were such "abortive 
cases" nevertheless taken to the same hospital and placed in contact 
with confirmed polio victims? Parents feared that such a measure 
effectively doomed children who did not have polio to contracting 
the disease in the institution. 49 Was it not preferable to leave suspects 
isolated in their own homes until a definitive diagnosis could be 
made? Why was this type of home quarantine allowed only for 
children of more affluent families? The public health measures dis- 
criminated against the poor who were often immigrants living in 
crowded conditions; many parents were unable to provide the nec- 
essary space and care for their offspring. 50 

A topic of frequent debate at town council meetings and in the 
press was the meaning and impact of the local public health mea- 



46. On 12 August, the East Norwich Enterprise announced that Dr. Linsly R. 
Williams, deputy health commissioner of the State of New York, had received a 
letter from Roosevelt pledging support for a campaign to outfit a new emergency 
hospital. 

47. Minutes of regular meeting, Sea Cliff Board of Health, 21 August and 18 
September 1916. 

48. In his report, Overton declared that "the parents of the children who entered 
the hospitals were almost unanimous in praise of the institutions." Overton, "Control 
of Poliomyelitis," p. 448. 

49. O.B.G., 1 1 August 1916. Haven Emerson insisted that hospitalized children 
had fewer complications since they were under the care of a "great quartet": pediatri- 
cian, pathologist, orthopedist, and neurologist. By contrast, many of the suspects 
staying home were neglected. Haven Emerson, "Discussion of Symposium on Polio- 
myelitis," Long Island Medical Journal, 1916, 10:467-468. 

50. Rogers, Dirt and Disease will discuss the widespread ethnic and class dis- 
crimination during the 1916 epidemic. Home quarantines were routinely flaunted. 
One witness from New York, Janet Sommers, recounted: "I remember being quaran- 
tined. We were not allowed to go out. Food was passed into us through the window 
and about 11—12 [o'clock] at night my mother did sneak us out just to walk the 
street and back," in Neil M. Cowan and Ruth Schwartz Cowan, Our Parents' Lives: 
The Americanization of Eastern European Jews (New York: Basic Books, 1989), p. 
128. 



Revolt Against Quarantine 



37 



sures on Oyster Bay. Business was seriously affected as fears about 
polio prompted an exodus of regular summer visitors. There was a 
drop in sales and services, causing unemployment among the local 
work force. At the same time, there was a feeling that the regulations 
were arbitrarily enforced in the village. Some families were quaran- 
tined where no disease existed, while for others, when polio was 
found, quarantine rules were disregarded; parents and vendors were 
virtually free to come and go. The latter problems challenged the 
professional authority of local and state health officials in matters 
pertaining to the epidemic. Not only was the apparent inconsistency 
of most preventive measures such as hospital and home isolation 
challenged, but the multiple theories of disease transmission and 
susceptibility created widespread confusion and doubts about the 
value and fairness of public health laws. Local physicians tending 
to the sick were deemed somewhat more knowledgeable about polio 
than officious health bureaucrats who represented the state. In the 
midst of all the cleanup and quarantine rhetoric, citizens recom- 
mended traditional home remedies to fight the disease. 51 

Citizens' Revolt 

On 28 August, Judge Steinert, temporary chairman of the town 
board, adjourned a rather tumultuous town meeting in Oyster Bay. 
During that session, reports about the progress of the polio epidemic 
presented by health officer Burns and a state health department 
official had been frequently interrupted and criticized by an unruly 
crowd. The total count had reached one hundred cases in the town- 
ship; 73 had occurred during the month of August. Part of the 
mounting anger and frustration stemmed from the fact that the toll 
from the disease continued to rise. Another reason was a recent 
episode in which two health officers and four deputy sheriffs had 
forcibly removed a sick child from its father to take it to the quaran- 
tine hospital. 52 As the meeting came to an end, a group of about 
160 local residents, crowded in the room, took over. Led by J. 



51. Editorial, O.B.G., 25 August 1916. A reader signing his letter as "X Ray," 
delivered a blistering attack on the medical profession, blaming physicians for the 
prevailing state of hysteria in the village of Oyster Bay. 

52. Unless otherwise stated, quoted material regarding discussions and events 
at the 28 August town council meeting is from the minutes of the Oyster Bay town 
council meeting, 28 August 1916. 



38 



GUENTER B. RlSSE 



Franklyn Underhill of Glen Cove and Henry Montague Bennett 
from Oyster Bay, 54 this new citizen's group quickly established its 
own sanitary committee charged with drafting new rules to manage 
the polio epidemic. Foremost among them was the demand to repeal 
the regulation allowing the removal of suspected children to an 
isolation hospital without parental consent. 

The lengthy document drafted by the followers of Underhill 
and Bennett highlights the tensions between popular and scientific 
views of polio, exacerbated by the chasm between laboratory and 
clinical models of disease. Oyster Bay citizens objected vehemently 
to the public health measures ostensibly instituted to protect them. 
The medical profession, including practitioners and medical scien- 
tists, was generally accused of creating a state of "frenzy and terror" 
by providing confusing information about "mysterious germs or 
miasmas." Critics suggested that these theories were designed more 
to buttress their fame, power, and "greed for gold" than to help 
sick people crippled by the disease. 55 In this connection, repeated 
diagnostic lumbar punctures came under special attack as causing 
additional cases of paralysis. 56 Contemporary bacteriological re- 
search was severely criticized, especially activities sponsored by en- 
dowments from philanthropists such as Rockefeller and Carnegie 
that were "actuated by a desire to return a small measure of good 
for the millions which they have extorted from the common peo- 
ple." 57 At the same time, the authors reiterated their respect for 
"those great minds among physicians and surgeons" whose devo- 
tion to mankind had brought so "many wonders in science and 



53. J. Franklyn Underhill belonged to a prominent Long Island family. See 
Josephine C. Frost, ed., Underbill Genealogy (Underhill Society of America, 1932), 
3:849. 

54. Henry M. Bennett was a friend of former president Roosevelt and a republi- 
can boss in Nassau County. Three months later, as he planned to become a candidate 
for supervisor from the Oyster Bay township, he was accused of having accepted a 
bribe to influence the vote of a juror in a lawsuit before the State Supreme Court. 
Bennett was arrested, then convicted of attempted bribery, and sentenced to five 
years in Sing Sing Prison. New York Times, 22 November 1916 and 24 June 1917. 

55. "The crippling and maiming of future generations is lost sight of in the 
greed for gold and the lust for political power." 

56. Dr. George Draper initiated diagnostic spinal punctures on 31 July. They 
were performed in doubtful cases without paralytic symptoms. During the middle 
of August, the additional diagnosticians from the State Health Department were 
performing 30 or more procedures per day. See Overton, "Control of Poliomyelitis," 
p. 446. 

57. Minutes, Oyster Bay town council meeting, 28 August 1916. 



Revolt Against Quarantine 



39 



innumerable blessings to the world." 58 Spared from criticism was 
the family doctor "whose trying ordeals, patience, kindliness, and 
comforting counsel have endeared him and given him a permanent, 
abiding place in the hearts of all." 59 

Public health officials were also heavily censured, with a resolu- 
tion declaring that "both profane and modern history are replete 
with the medico politico barbarism which we are now experiencing, 
as anyone who reads the history of quarantine must understand 
and acknowledge." 60 The "hysterical inconsistencies of the present 
quarantine" were highlighted, including the "brutal removal" of 
children from their parents and the "alarmist reports of health 
officers." The frequent use of statistics to demonstrate the magni- 
tude of the epidemic was judged as self-serving "to maintain the 
quota of patients and medical staffs at the improvised hospitals." 61 
There were bitter complaints about using tax funds and voluntary 
donations to support public health activities. It was thought that 
such financing perpetuated bureaucratic organizations while ensur- 
ing seasonal visitations by an epidemic disease "which the skillful 
publicity man of these public parasites can invent to compel contin- 
ued contributions." 62 

Indirectly, the Roosevelt Committee was also rebuked. Con- 
ducting inspections, hiring watchmen, and obstructing highways 
were deemed to be illegal actions, "detrimental of every business 
interest as well as to the welfare of the community in general." 63 
Because of his "great heart and love of mankind," Oyster Bay's 
leading citizen, former President Roosevelt, was portrayed as being 
merely the tool of a group of misguided locals, eager to emulate 
the medical profession "in taking a leading part in scaring those to 
death who are not already infected with the money-grabbing incu- 
bus of the medical profession." 64 



58. Ibid. See also Saul Benison, "Poliomyelitis and the Rockefeller Institute: 
Social Effects and Institutional Response," Journal of the History of Medicine, 1974, 
29:74-93. 

59. Minutes, Oyster Bay town council meeting, 28 August 1916. 

60. Ibid. "Inasmuch as our people have contributed so generously from their 
funds and sympathy, the State Board of Health and its satellites have been able to 
establish themselves in the wealthy section, and so long as funds are readily forthcom- 
ing and the taxpayers uncomplainingly shoulder their burdens, we can be expected 
to be visited each season by plague." 

61. Ibid. 

62. Ibid. 

63. Ibid. 

64. Ibid. 



40 



GUENTER B. RlSSE 



Finally, the Bennett group, "responsible for families of children 
of susceptible age," formally expressed its sympathy with those who 
had actually been afflicted by the disease. The epidemic was said to 
be coming to an end thanks to the "visitation of Jack Frost." It 
was necessary to effect a "discharge of the medical maniacs, the 
resumption of local business, the recall and restoring to confidence 
of our easily scared summer residents, and the application of com- 
mon horse sense to the co-called epidemic with which this and other 
communities have been afflicted." 65 To this effect, the group lobbied 
for highway watchmen to be withdrawn. First and foremost they 
called for the repeal of local ordinances ordering mothers to surren- 
der children suspected of harboring polio to the health authorities 
for isolation. In the view of the committee, it excited mothers "to 
frenzy and terror," and forced them to hide "stricken children rather 
than suffer them to be seized and dragged away." 66 If these recom- 
mendations were not implemented, the group threatened to petition 
the governor and request the removal of the local health officer as 
well as all local authorities opposed to the recommendations. 

Not surprisingly, an editorial in the Brooklyn Eagle on 29 
August expressed "universal sympathy" with the resolutions 
adopted by the Bennett committee in Oyster Bay. 67 Another sup- 
portive editorial under the banner "Oyster Bay Rises in Majesty" 
appeared in the New York Times. Yet, as the editors also pointed 
out, polio was communicated by contact with children suffering 
from the disease and their isolation was absolutely necessary. As an 
aside, the Times writer wondered about the reaction of the village's 
elder statesman and whether he would forcefully reply to the insinu- 
ations since "he does not consider himself a naive or unsophisticated 
person." 68 The Oyster Bay Guardian, for its part, in commenting 
on the sprouting of citizens' committees, indicated that "hysteria 



65. Ibid. 

66. Ibid. 

67. Editorial, Brooklyn Eagle, 29 August 1916. However, the author of this 
article also declared that "this is a time when patience and moderation are needed 
among parents and when patience and conciliatory ways are almost as much needed 
among physicians as professional skill." See also New York Times, 29 August 1916. 
The headline in this paper read "Townsmen Blame the Corruption of Men and 
Microbes by Rockefeller Millions." 

68. "The Colonel is likely to make remarks as a result of having been accused 
thus of gullibility, and when he has an elevation either of temperature or of temper, 
noises audible for long distances are usually heard coming from his direction." Netv 
York Times, 29 August 1916. 



Revolt Against Quarantine 



41 



seems to have taken possession of a large number of people." This 
was understandable, given the unpredictable spread of polio even 
among the well-to-do. Despite Simon Flexner's experimental work, 
the true sources of infection and transmission of polio were still in 
doubt, thus the ineffectiveness of public health measures. These 
remarks were echoed by another local newspaper, the Sea Cliff 
News, which also complained about the "autocratic and czar-like 
methods" of the health department. 70 

On 1 September, members of the Bennett committee attended 
the town council meeting and requested the repeal of all quarantine 
measures, especially in view of the fact that the epidemic was abat- 
ing and the situation in the village was less critical than during 
previous months. Judge Steinert categorized the reform-minded 
group as troublemakers and "rowdies." This characterization an- 
gered Colonel Bennett and led to a sharp exchange between the two 
men which ended with Bennett being ejected from the room and 
the abrupt adjournment of the meeting. 71 Thwarted in their efforts 
to procure official sanction for their resolutions, the Bennett forces 
nevertheless claimed a small victory. The Roosevelt committee 
agreed to dismiss the visiting village physician, William T. Jenkins, 
who was a former health officer for the Port of New York, together 
with five watchmen, ostensibly because of the waning of the 
epidemic. 

Three days later, on 4 September, a large crowd attended the 
meeting of the Oyster Bay town council. Six new cases of polio 
had been reported. The session was later described as a genuinely 
democratic town meeting attended by businessmen, clergy, physi- 
cians, workmen, and parents of children affected by the public 
health regulations. After some routine matters, the session turned 
into a public hearing on the disputed health-related issues. The 
previously drafted resolutions of his committee were read and offi- 
cially placed on file, and Colonel Bennett then took to the floor, 
acting "after the manner of a schooled lawyer." 72 Several contempo- 
rary articles and pamphlets on polio written by prominent physi- 
cians were read and entered into the record as evidence. The printed 



69. O.B.G., 1 September 1916. 

70. Sea Cliff News, 2 September 1916. 

71. "Pandemonium at Board Meeting," O.B.G., 1 September 1916. See also, 
Minutes, Oyster Bay town council meeting, 1 September 1916. 

72. "People Have a Say: All Classes Appear before Board of Health," O.B.G., 
8 September 1916. 



42 



GUENTER B. RlSSE 



word was supplemented with letters from individual practitioners 
and members of medical organizations. Bennett's point was that, 
grave as it was, the polio problem could have been managed far 
better with less publicity and less participation by prominent medi- 
cal men who were protective of their professional reputations. The 
epidemic had been exaggerated by medical "propagandists," thus 
creating a climate of fear and panic. 73 

As expected, Bennett was equally critical of the public health 
officials, especially of the forcible removal of children to the isola- 
tion hospital. Reading signed statements from various Oyster Bay 
residents, including two Polish fathers, Bennett vividly emphasized 
the predicament of such deprived parents, often immigrants, who 
were not informed about the progress of their offspring in the 
"pesthouse" and were not allowed to visit them. Seventeen addi- 
tional Polish children had been reported as suffering from polio 
during the month of August, half of them living in the "Pine Hol- 
low" section of the village. Nearly two-thirds of the children, many 
of them infants, were summarily sent to the isolation facility at 
Hicksville. 74 For those victims remaining in their homes, officials 
placed polio signs at the doors or in house windows in a somewhat 
arbitrary fashion, even in homes where practitioners who had exam- 
ined the suspected children failed to make a definitive diagnosis of 
infantile paralysis. 75 

At this point in the discussion, both health officer Burns and 
Dr. George Draper from the state sanitary office at Roslyn requested 
to be heard. As Haven Emerson had done in New York City, Burns 
tried to reassure the audience that conditions at the isolation hospi- 
tal were excellent, and that children were properly cared for in such 
institutions. However, he insisted that the six-week isolation period 
for all victims was necessary to prevent further contagion. Draper, 
for his part, was somewhat stumped by the argument from an 
Oyster Bay resident who found it absurd that mothers were allowed 
to visit their recovering children in the isolation hospital, and could 



73. Those in charge of the public health campaign, by contrast, were proud of 
their educational efforts and the distribution of thousands of circulars to health 
boards as well as the placing of advertisements in newspapers. See Overton, "Control 
of Poliomyelitis," p. 448. 

74. Data from the polio reporting cards, New York State Archives, Albany, 
New York. 

75. According to one author, "very few physicians on Long Island were prepared 
to diagnose a case unless a paralysis was so evident that the mothers themselves 
recognized the case," Overton, "Control of Poliomyelitis," p. 446. 



Revolt Against Quarantine 



43 



come and go as they pleased. The mother of one quarantined child 
testified that the institution allowed her to assume some cleaning 
duties while visiting. These apparent inconsistencies in what was 
believed to be a strict quarantine made little sense to laypersons. 
Suggestions were made that conditions at the isolation hospital be 
investigated by an impartial medical officer. 

As the meeting continued, Draper launched into a vigorous 
defense of the medical profession, including those practitioners de- 
voted to public health. In his view they followed strict guidelines 
established by the state health department. He accused Bennett of 
"grossly slandering" physicians, and then launched into a long, 
technical discussion of the possible causes and oral transmission 
mechanisms of polio, a diatribe in which no new information was 
presented. Draper's comments caused the audience to make the 
criticism that if the oral transmission theory was correct, physicians 
were mostly responsible for the epidemic, as they carried the disease 
from house to house during their professional visits. While forced 
to acknowledge such a possibility, Draper argued that practitioners 
usually kept out of the "cough or speech line" of the patient during 
their examinations. Undaunted by this argument, Bennett concluded 
his lengthy presentation by returning to the central charge that local 
and state health officials had deliberately terrified the population to 
justify their professional standing. The hearing ended inconclusively 
without the town council taking any official action. 76 

The next day, however, the meeting resumed under the chair- 
manship of supervisor Cocks, who had been ill when the Bennett 
committee first presented its demands. Although the epidemic was 
still in progress, the Oyster Bay council voted to lift the ban forbid- 
ding children under the age of 16 to attend camp meetings, picnics, 
motion picture shows, and other public gatherings. Moreover, in 
conformity with the actions of the Roosevelt committee, it laid off 
all highway watchmen and sanitary inspectors hired to enforce the 
quarantine, de facto lifting it. However, a motion by Cocks to 
rescind that section of the health code mandating isolation of sus- 
pected polio cases was defeated by his colleagues on the board, 
Steinert and Duvall, in spite of a petition to repeal it signed by 
nearly three hundred residents. The ensuing turmoil featured the 
Cocks and Bennett partisans on one side, pitted against justices 
Steinert and Duvall, town clerk Weeks, and the public health offi- 



76. Minutes, Oyster Bay town council meeting, 4 September 1916. 



44 



GUENTER B. RlSSE 



cials. The meeting was quickly adjourned. Cocks insisted that since 
the quarantine regulations were unconstitutional, they did not re- 
quire an annulment. He offered to provide free legal assistance to 
anyone wishing to challenge public health ordinances. Outside the 
town hall, "high health officials" (presumably Draper and his assist- 
ants) now confided to a dwindling audience that public health work 
in the village had indeed been mismanaged from the start, a veiled 
reference to health officer Burns's apparent lack of tact. 77 

The next issue of the Oyster Bay Guardian carried an editorial 
that blamed the villagers' frustration with the epidemic on the ac- 
tions of public health officials. Titled "What Are We to Believe?" the 
article once more enumerated the three problematic issues: doubts 
about the authority of medical knowledge in the diagnosis of polio; 
lack of proper treatment; and the apparent "brutality of the quaran- 
tine." In the laity's view, common children's summer diseases were 
now routinely diagnosed as polio " as a matter of safety." Given 
the subsequent hardships of quarantine and hospitalization for the 
presumed victims and their families, this rather casual professional 
action was found unacceptable. Moreover, there was an inherent 
danger in spinal punctures, and in addition the negative results of 
laboratory spinal fluid analyses inevitably arrived too late to prevent 
suspected cases from being carted off to hospitals or dreaded signs 
being placed on doors and windows of quarantined houses. 78 

A week later on 12 September, a crowd assembled for the town 
council meeting "evidently expecting pyrotechnics," because rumors 
were circulating in the village that quarantine measures were to be 
reinstated. Health officer Burns reported an additional six polio 
cases, four of them from Glen Cove — hardly an indication that the 
epidemic had subsided. Responding to questions, Burns emphasized 
that Oyster Bay had no jurisdiction over the reporting and transfer 
of suspected polio cases. State health regulations could be neither 
modified nor repealed by local units of government. Faced with 
such legal barriers, and feeling uneasy because polio persisted, mem- 
bers of the council reluctantly tabled a proposal by the Bennett 
committee to revise or rescind such health rules. 79 

On 15 September, the Roosevelt committee issued its report. 
The document confirmed that workers were hired to remove accu- 



77. Minutes, Oyster Bay town council meeting, 5 September 1916. 

78. Editorial, "What Are We to Believe?" O.B.G., 8 September 1916. 

79. Minutes, Oyster Bay town council meeting, 12 September 1916. 



Revolt Against Quarantine 



45 



mulated rubbish in the village, and six quarantine watchmen were 
employed to be positioned at all points of entry to the town in order 
to intercept visitors without health certificates. Committee members 
took pains to state that their activities had not been meant to usurp 
functions entrusted to public health officials who, in their view, had 
"acted with coolness and judgment." Nevertheless, to assist Burns 
with the identification and disposition of suspected polio cases, the 
group had engaged another physician and a trained nurse. Further 
support was provided to set up the isolation hospital in Hicksville 
and equip Draper's station at Roslyn. Finally, the committee also 
claimed to have distributed funds to quarantined households "pro- 
vided such parties were found worthy and obedient to the regula- 
tions imposed." According to records, about 150 subscribers had 
donated a total of $5,000 with additional pledges doubling that 

C 80 

sum or money. 
Epilogue 

The total count of reported polio cases for September in the Oyster 
Bay Township was 20, with only one Italian and two Polish victims 
listed. The fear that immigrants were prominently involved in 
spreading the contagion ebbed. The feast of St. Rocco, which had 
been postponed since August, took place and attracted thousands 
of visitors to the village. The usual Columbus Day celebrations and 
a firemen's tournament took place without restrictions. The U.S. 
Public Health Service discontinued the federal inspection of travel- 
ers leaving New York City on 14 October. At the suggestion of 
health officer Burns, the isolation hospital was to be closed in No- 
vember. As a grim reminder, two "polio clinics" or educational 
sessions were scheduled for late October in Glen Cove and Oyster 
Bay, to be attended by medical experts and parents of the victims to 
discuss muscular atrophy, paralytic symptoms, and other sequelae. 
Time-consuming and often frustrating rehabilitation efforts were 
discussed. 81 

The battle, however, had not ended. In a last gasp, polio re- 
turned on 30 November, striking six children in Oyster Bay, Locust 



80. "Work Done by Oyster Bay Sanitary Committee," dated 9 September 1916 
in Oyster Bay. See O.B.G., 15 September 1916. 

81. A. Whitman, "Poliomyelitis As a Public Problem," New York State Journal 
of Medicine, 1917, 17:259—264; see also W. Truslow, "Prevention and Correction 
of Deformity in Poliomyelitis," Long Island Medical Journal, 1916, 10:453-455. 



46 



GUENTER B. RlSSE 

Oyster Bay, New York 
Polio Epidemic 1916 



20 

Number of 
Cases 



I 





minimi 



Julyl- July 9- July 16- July 23- July 30- 
July8 July 15 July 22 July 29 Aug 5 



Aug 6- Aug 13- Aug 20- Aug 27- Sept 3- 
Augl2 Aug 19 Aug 26 Sept 2 Sept 9 



Sept 10 
Sept 16 



Figure 3. 



Valley, and Hicksville. The final tally for the township was 130 
cases, of which 63 were sent to isolation facilities. 82 The village of 
Oyster Bay reported 44 cases, nine per one thousand population 
compared with 1.6 per one thousand in New York City and 0.6 per 
one thousand for most cities in upstate New York. 83 For the 1916 
epidemic, the total number of polio cases reported in the entire state 
outside of New York City was 4,214 with a mortality rate of 
26 percent. Nassau County alone registered 482 with an average 
mortality rate of 25 percent (see Fig. 3). 

We owe our knowledge of the extraordinary events in Oyster 
Bay to dispatches from a reporter of the New York Times stationed 
in the village during the summer of 1916. Searching for quotable 
statements from the inimitable former president, this journalist 
stumbled across a cleanup campaign launched by notable summer 



82. This data was also obtained from individual reports filed with the State 
Health Department in Albany. Again, no deaths can be ascertained from the docu- 
mentation but the mortality rate for Nassau County was estimated to be 25 percent. 
Twelve of the 130 cases were identified as Italians, 24 were Polish. 

83. See M. Nicoll, Jr., "The Epidemic of Poliomyelitis in New York State in 
1916," New York State Medical Journal, 1917, 17:270-274. 



Revolt Against Quarantine 



47 



residents as the toll from polio mounted and the epidemic spilled 
from ethnic neighborhoods to the population-at-large. Even those 
adults who worked on estates, such as chauffeurs and gardeners, 
were not spared. 

As it did everywhere, the polio epidemic in Oyster Bay gener- 
ated many scapegoats, from Italian and Polish immigrants to public 
health officials. Class and ethnicity played major roles when blame 
for the epidemic was assigned as well as when individuals were 
targeted for quarantine. When the epidemic was over, Italians con- 
tributed close to 10 percent of the reported victims, the Poles more 
than 18 percent. 84 Cultural stereotypes were bountiful, from Italians 
who ostensibly needed to be taught cleanliness to become full- 
fledged American, to emotional Polish fathers who, as irrational 
obstacles to public health, needed to be restrained by police as their 
children were dispatched to isolation hospitals. 

Economic issues were never far from the center of spirited 
debates. Local authorities and commercial interests in Oyster Bay 
wavered between permissive policies that might import disease 
along with tourism, and strict quarantine regulations that would 
cripple local business. Ironically, during that summer, both ap- 
proaches would contribute to Oyster Bay's reputation as the "pest 
hole" of Long Island. Anxiety would prompt an exodus of summer 
residents, and the attendant loss of revenues and unemployment 
would compound the problems of the declining fisheries. There 
were also traditional tensions between permanent residents and 
well-to-do summer visitors ensconced in their lavish estates. Al- 
though the former were responsible for providing an acceptable 
infrastructure on which local tourism and commerce could flourish, 
landowners seldom cared about local needs unless their own well- 
being was threatened. To raise local taxes was to commit political 
suicide. Overwhelmed by the growing demand for more services, 
the township with its modest revenues simply failed to provide 
them, exposing the lack of such basic sanitary infrastructure as 
sewers and garbage dumps. Health-related expenditures ranked low 
on the list of local priorities — even the "niggardly" expenditure 
for the salary of a health officer was deemed a waste! 

To a lesser degree, such issues were influenced by political 
considerations. Roosevelt and Bermingham represented the wealthy 



84. In the United States census of 1920, Italians constituted only 3.4 percent of 
the population living in Nassau County; at 2.8 percent Poles made up even less. 



48 



GUENTER B. RlSSE 



businessmen, physicians, and landowners of the township, all of 
whom were staunch Republicans. Both Steinert and Duvall, nick- 
named the "little judges," were also Republicans, perennially drag- 
ging their feet and failing to prosecute the rich and powerful, even 
when the local health officer identified them as apparent violators 
of sanitary laws. Duvall was later accused of issuing pistol permits 
without sufficiently investigating the applicants. Colonel Henry 
Bennett was an exception. He was the Republican political boss in 
Nassau County, and a friend of Roosevelt; yet Bennett was a man 
prone to espouse populist causes if it suited his politics and ego. 
Only supervisor Cocks, the chairman of the board of supervisors 
at the time, was a Democrat with a proven record of championing 
the causes of poor people. 85 During meetings of the Oyster Bay 
council, he frequently remained at odds with his colleagues on the 
board, opposing the actions of health officer Burns as autocratic 
and unsympathetic to the plight of the lower-class immigrants 
Cocks sought to protect. His actions were endorsed by Democratic 
newspapers such as the Oyster Bay Guardian, the Sea Cliff News, 
the Glen Cove News, and the East Norwich Enterprise. 

Events in Oyster Bay during the summer of 1916 exposed 
serious cracks in the professional authority enjoyed by American 
doctors. The polio epidemic starkly revealed the impotence of physi- 
cians who represented the new "scientific" medicine. The Pasteurian 
revolution claimed to have enabled scientists to pinpoint polio's 
etiological agent. However, in the face of a very threatening disease 
with significant mortality and permanent, deforming complications 
that terrorized the population, physicians seemed bewildered and 
divided about the locus and mechanisms of polio transmission. 86 
What was a "virus?" Was it really contagious? How could it be 



85. James H. Cocks, originally postmaster of Glen Cove during the administra- 
tion of president Grover Cleveland, served three terms as a member of the board of 
supervisors of the Oyster Bay Township, retiring from active politics in December 
1916. He was president of the Nassau Union Bank and "the foremost Democratic 
leader" of the county. See obituaries in Nassau Daily Star and Nassau Daily Review, 
23 October 1929. Other biographies are contained in Henry I. Hazelton, The Bor- 
oughs of Brooklyn and Queens, Counties of Nassau and Suffolk, Long Island, New 
York, 1609-1924 (New York: Lewis Historical Publishing, 1925), 5:86. 

86. Overton blamed physicians for failing properly to inform the public, feeding 
"medical pablum" instead. Overton, "Control of Poliomyelitis," p. 447. A recent 
reexamination of this question can be found in N. Nathanson and J. R. Martin, 
"The Epidemiology of Poliomyelitis: Enigmas Surrounding Its Appearance, Epide- 
micity, and Disappearance," American Journal of Epidemiology, 1979, 
11 0:672-692. 



Revolt Against Quarantine 



49 



transmitted ? Why were so many children spared ? Dangerous diag- 
nostic techniques such as spinal taps, the limited technical ability 
correctly to diagnose and make a prognosis, and untried as well as 
ineffective vaccines 88 failed to stem the natural history of the dis- 
ease, thus creating widespread public skepticism and outright 
distrust. 89 

Epidemiological debates concerning the importance of filth, 
the role of flies, and healthy carriers only created more confusion. 
Public health campaigns mounted by local health departments both 
in New York City and Oyster Bay focused on the role of garbage, 
and were beholden to the older miasmatic paradigm that could be 
conveniently linked through flies with the polio microorganism. In 
New York, thousands of volunteers were mobilized in a war against 
filth. Street cleaning and removal of refuse became patriotic duties 
which no responsible American could ignore. Flyswatters and 
screens to fend off the pesky stable flies were widely distributed to 
the public. 90 Roosevelt and his committee targeted backyard rub- 
bish heaps, manure pits in stables, clogged gutters, and overflowing 
water closets. 

What appears most remarkable from the debates and the citi- 
zens' revolts at Oyster Bay was the low esteem in which the medical 
profession was held by the public. Physicians, especially the public 
health officials, were repeatedly branded as being heartless, auto- 
cratic, and incompetent. Residents of Oyster Bay, many of them 
recent immigrants, vigorously opposed disease control strategies 
that resorted to coercion without furnishing plausible reasons for 
the measures proposed. "Times have changed," wrote one local 
editorialist, "the old family physician whose entire life and skill was 
devoted to his neighbors and friends is rapidly becoming simply a 
pleasant memory." 91 In his place, a new school of physicians "mak- 
ing their profession a business" had emerged, and there was a feeling 

87. For a review of the public's involvement with the germ theory, see Nancy 
Tomes, "The Private Side of Public Health: Sanitary Science, Domestic Hygiene, 
and the Germ Theory, 1870-1900," Bulletin of the History of Medicine, 1990, 
64:509-539. 

88. C. W. Wells, "Immune Human Serum in the Treatment of Acute Poliomyeli- 
tis," JAMA, 1916, 67:1211-1213, and Rogers, Dirt and Disease. 

89. "There are some who say that our efforts were of no avail and that the 
disease burned itself out from lack of susceptible persons," Overton, "Control of 
Poliomyelitis," p. 446. 

90. Naomi Rogers, "Germs with Legs: Flies, Disease, and the New Public 
Health," Bulletin of the History of Medicine, 1989, 63:599-617. 

91. Editorial, Sea Cliff News, 2 September 1916. 



50 



GUENTER B. RlSSE 



that high-paying customers were entitled to proper communication 
and explanation. "The American public will not submit to frequent 
insult to their intelligence. Every intelligent man and woman in the 
town of Oyster Bay will do his or her utmost to help stamp out 
any contagious disease, but they are going to insist on facts being 
intelligently told to them by competent authorities." 92 In a warning 
to future health policy makers and officials, the writer concluded: 
"Unless there is a material change in the methods employed by 
men in official positions charged with safeguarding the health of 
communities, the actions of the Oyster Bay citizens will be a com- 
mon occurrence in other localities." 93 

For the past 10 years, American society has responded in mani- 
fold and often contradictory ways to the AIDS epidemic. These 
events make it imperative that we study in detail the complex web 
of factors involved in such reactions to mass disease. Historians 
have an obligation to examine past epidemics and provide new 
perspectives for understanding them. The story of Oyster Bay's 
revolt against public health measures instituted during the polio 
epidemic of 1916 offers a number of useful parallels, especially the 
ambiguity of medical science, the stigmatization of minorities, and 
the institution of policies driven by fear. 

Department of the History of Health Sciences 
University of California, San Francisco 
533 Parnassus Avenue 
San Francisco, CA 94143—0726 



92. Ibid. 

93. Ibid. 



A Tale of Pursuing Health Deception 



JAMES HARVEY YOUNG 

When one stands at my point along life's trail, he is tempted to 
reflect on why, long ago, he selected, or was lured into, the theme 
upon which he has lavished the major portion of his research and 
writing and lecturing hours. In my case, up to this congenial mo- 
ment, that total accumulates to 6,820 hours. So indulge me, please, 
while during this 6,821st hour, I seek to recapture reasons that led 
me to begin a pursuit of the history of health deception. 

My first publication that had anything to do with science came 
when I was in the fifth grade. The short piece appeared in a Sunday 




Figure 1. Hypnotizing the chicken, Brimfield, 111., circa 1927. 

Photograph by William Harvey Young. Courtesy of Barbara Young, Baltimore, Md. 



This paper was presented, in a slightly different form, as a Francis C. Wood 
Institute for the History of Medicine Seminar on 26 September 1991 at the College 
of Physicians of Philadelphia. 

51 

Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 51-72 
© 1992 by The College of Physicians of Philadelphia. 



52 



James Harvey Young 



School paper accompanied by this picture taken by my father (see 
Fig. 1). The article bore the title "How to Hypnotize a Chicken." 
You observe the chicken and me, the mesmerist, and my awed 
siblings and playmates. The paper circulated widely, even into all 
foreign lands to which the Congregational denomination had sent 
missionaries, and I received many letters from afar: China, Malay- 
sia, Australia. This response augmented my stamp collection, bol- 
stered my ego, and gave me an inkling of the pleasure to be derived 
from seeing one's words in print. Most of the mail had a testimonial 
flavor: "I could not believe the promise of your headline," my 
correspondents wrote, "but then I got a chicken and tried your 
method and, to my amazement, it worked at once and continued 
without fail." The residual impact of this correspondence may have 
aimed my curiosity in later years at the hundreds of testimonials in 
patent medicine advertising. These might be slyly remote, trafficking 
on the valor of a former president (see Fig. 2). Or they might grandly 
display one of the nation's proud patriotic symbols while citing 
praise from its French designer (see Fig. 3). Or they might be 
astoundingly current and politically correct (see Fig. 4). Pe-Ru- 
Na, a high-alcoholic nostrum, one House member averred, had 
"rejuvenated" so many members of Congress that it was certainly 
"the favorite Congressional drink." 1 Or they might be collected for 
a very small fee from the country's centenarians. To be fair, I must 
add that Native Americans, whom I showed as enemies a minute 
ago, appeared much more often in patent medicine promotion as 
benefactors of white men and women, giving to them in their cities 
the healing plants of nature found in the woods (see Fig. 5). 

During my chicken-hypnotizing phase, three other experiences 
occurred that, I believe, may have bent the twig of my interest. 
During several summers I visited an uncle who was a country doctor 
in Iowa. I accompanied him on his rural rounds and occasionally 
stood by to help him in an emergency, on one occasion, for example, 
holding the basin while he washed away blood and sutured cuts 
sustained by a young couple when they wrecked their car hitting a 
hog in the road. About the same time, I read with great fascination 
Paul de Kruif 's Microbe Hunters 2 and Sinclair Lewis's Arrowsmith. 3 
Many years later, I was impressed at discovering how many reform- 

1. James Luther Slayden of Texas in Congressional Record, 59th Congress, 1st 
Session, 22 June 1907, p. 8987. 

2. Paul H. de Kruif, Microbe Hunters (New York: Harcourt Brace, 1926). 

3. Sinclair Lewis, Arrowsmith (New York: Harcourt Brace, 1925). 



Pursuing Health Deception 



53 




54 



James Harvey Young 




Painting of the Statue of Liberty in the Harbor of New York. 
Presented to M. Mariani by II \rt uoldi. 

"Vin Mariani" seems to brighten and increase all our faculties; this 
precious wine Will give me the strength to carrv out certain other pro- 
jects already formed, for which accept thanks from yours cordially: 
Commandeur Legion d'honneur. Bartholdi. 

Figure 3. Frederic Auguste Bartholdi, designer and builder of the Statue 
of Liberty, praises a wine and coca nostrum that developed a large interna- 
tional market. 

Facing title page of Mariani & Co., Collective Testimony of the Benefit and Virtue of the Famous 
French Tonic Vin Mariani (New York: Mariani 8c Co., 1910), in the Collections of the Library 
of Congress, Washington, D.C. 



56 



James Harvey Young 




*■ 3® PILLS 




9 

Figure 5. On this mid-nineteenth-century pill box label, white man's civili- 
zation flourishes across the river, but in the foreground the red man prom- 
ises botanicals he has discovered in the forest to cure the white man's ills. 

From the author's collection. 

ers during the Progressive period remarked in their autobiographies 
that reading Henry George's Progress and Poverty in their youth 
had been a powerful formative influence in their lives. I have won- 
dered if reading Microbe Hunters and Arrowsmith may not have 
played a similar role for a generation of physicians. The significant 
linkage between de Kruif and Lewis I was not to learn until I read 
Charles Rosenberg's illuminating article, "Martin Arrowsmith: The 



Pursuing Health Deception 



57 



Scientist as Hero," in the American Quarterly. 4 The two books and 
my uncle influenced me, I am sure, but not toward a career in 
medicine; I cannot recall ever having harbored that ambition. Per- 
haps the chicken testimonials had already pointed me too firmly in 
a deviant direction, a direction bolstered by seeing a quack in action. 

Itinerant medicine men were still on the move in my youth, 
although the traveling troupe was almost gone, the coup de grace 
the lack of tires in World War II. During the second half of the 
nineteenth century, medicine shows of all magnitudes had traversed 
the nation. The young James Whitcomb Riley, for example, spent 
the summer of 1872 traveling in rural Indiana with eccentric Doc 
McCrillus of Anderson. 5 Riley painted signs for Doc's Standard 
Remedies on fences and barns (see Fig. 6). "His marvelous brews 
and concoctions," Riley asserted, "relieved every form of distress 
from 'The pinch of tight shoes, to a dose of the blues' " 

Three years later, Riley joined Dr. C. M. Townsend of Lima, 
Ohio, in promoting King of Coughs, Magic Oil, Cholera Balm, and 
Worm Candy in Indiana. Traveling in a covered wagon, Townsend's 
troupe, at the outskirts of a town, would arouse the population 
with blasts from a horn, then form a band and parade through the 
streets. Townsend gave afternoon and evening lectures. The versatile 
Riley, called the "Hoosier Wizard," would beat the bass drum, 
sing ballads, give readings, act in skits, and draw cartoons on a 
blackboard while his employer extolled the merits of his medicines. 
"Last night in Winchester," the poet wrote, "I made a decided 
sensation by making a rebus of the well-known lines from 
Shakespeare — 

Why let pain your pleasures spoil, 
For want of Townsend's Magic Oil? 

Most small-scale medicine shows were neither so moral nor so 
literary. 6 This was true of the nostrum vendor whose pitch — there 
was no accompanying entertainment — I harkened to back in my 
boyhood at the bandstand of my Illinois village. To persuade people 
to buy his bottled liniment, he poured a dollop on one side-of a 



4. Charles E. Rosenberg, "Martin Arrowsmith: The Scientist as Hero," Ameri- 
can Quarterly, 1963, 15:447-458. 

5. Marcus Dickey, The Youth of James 'Whitcomb Riley (Indianapolis, Ind.: 
Bobbs-Merrill, 1919), pp. 105-131 and 193-215; Richard Crowder, Those Innocent 
Years (Indianapolis, Ind.: Bobbs-Merrill, 1957), pp. 57-63 and 68-72. 

6. Brooks McNamara, Step Right Up (New York: Doubleday, 1976). 



58 



James Harvey Young 



S 




Figure 6. The Hoosier poet, James Whitcomb Riley, in his young man- 
hood designed this Standard Remedy trademark for a traveling medicine 
show proprietor. 

Reproduced with the permission of Macmillan Publishing Company from Marcus Dickey, The 
Youth of James Whitcomb Riley (Indianapolis, Ind.: Bobbs-Merrill, 1922, renewed 1950), facing 
page 121. All rights reserved. 



Pursuing Health Deception 



59 



razor strop, displaying with a grand gesture how the oily liquid 
passed through the thick leather, emerging as a wet stain on the 
other side. His marvelous formula, the pitchman proclaimed, pos- 
sessing such palpable penetrating power, could, of course, speed 
through the human skin to ease muscular aches and pains, and, he 
added boldly, to heal more grievous ailments afflicting the organs 
inside the body. Many of my elders in the audience paid out their 
dollars for the liniment, but I remained dubious, sensing that the 
pitchman's mode of proof fell short of substantiating his broader 
claims. It was the purchasers who had been hypnotized. 

I moved to a larger town, although small enough to have a 
weekly newspaper on which I worked as both printer and reporter. 
So when I had finished high school and college and had gone on to 
graduate school at the University of Illinois, I decided I wanted 
to use the University's exceptional collection of the state's early 
newspapers as source material for my history master's thesis. My 
adviser, Theodore Calvin Pease, was utterly non-directive. He made 
no suggestions to his students, requiring them to come up with and 
test out their own proposals for theses. I decided to study how the 
early newspapers were financed, but I found there was insufficient 
source material. Then my long latent interest in the theme of health 
resurfaced, and I explored the way in which the newspapers pre- 
sented disease and health among the pioneering people. 7 The abun- 
dant patent medicine advertising served as the basis for my most 
original chapter. The clever nature of the brazen claims entranced 
me but did not overcome my skepticism lingering from the day I 
had listened to the liniment barker. 

In my early years of teaching at Emory University, I turned my 
patent medicine chapter into two articles. Then, one day in 1951, 
upon entering my classroom, I noticed a poster thumbtacked to a 
bulletin board. It announced that Louisiana state senator Dudley 
LeBlanc was bringing his Hadacol roadshow to Atlanta (see Fig. 
7). By then nationally known, Hadacol had begun as a Cajun phe- 
nomenon, boomed by French and English testimonials praising its 
efficacy for arthritis, asthma, diabetes, epilepsy, gallstones, heart 



7. James Harvey Young, "Disease and Patent Medicine in Southern Illinois 
before 1840" (M.A. thesis, University of Illinois, 1938). 

8. James Harvey Young, "Patent Medicine in the Early Nineteenth Century," 
South Atlantic Quarterly, 1949, 48:557-565, and "Patent Medicines: The Early 
Post-Frontier Phase," Journal of the Illinois State Historical Society, 1955, 46: 
254-264. 



60 



James Harvey Young 




Figure 7. Dudley LeBlanc of Louisiana promoted his gigantic revival of 
the old-time medicine show in 1951. 

From the author's collection. 



Pursuing Health Deception 



61 



trouble, high and low blood pressure, paralytic strokes, tuberculo- 
sis, and ulcers. Before reaching Atlanta, however, LeBlanc had 
shrunk the categorical claims for his vitamin-B-plus-iron-and-alco- 
hol concoction and given it instead a different purported prowess 
suggested by Hadacol's theme song, "What Put the Pep into 
Grandma?" Indeed, LeBlanc hired gag writers to create stories 
about Hadacol's aphrodisiacal potency. These tales were told by 
clowns and by LeBlanc himself on stage at his revival of the old- 
time medicine show inflated into gargantuan proportions. The night 
I attended, duly buying two bottles of Hadacol to secure the box- 
tops for my admission fee, the show was emceed by no less a figure 
than Jack Dempsey. Carmen Miranda represented Hollywood, and 
Hank Williams and Minnie Pearl sang country music. I had talked 
with two of LeBlanc's advance agents before he came to town and 
was supposed to interview him after the evening performance. He 
departed, however, before it ended. 

What struck me with great force about the Hadacol show was 
that, for all its modern flair, at heart its basic psychology in hyping 
a nostrum distinctly resembled that of patent medicine promotion 
in the early Illinois press. Here were two points on a time line 
that demanded tracing. I wrote a short piece on Hadacol for my 
university quarterly and began in earnest the research for a book. 9 
Physicians and pharmacists, through the course of American his- 
tory, had paid heed to proprietary nostrums, condemning their 
deceptions and dangers. A notable member of the College of Physi- 
cians of Philadelphia, S. Weir Mitchell, told of seeing a self-pro- 
claimed eye doctor's sign in the lobby of a small hotel, promising 
that the "doctor" could restore sight to the blind by removing the 
offending eye, scraping its back, and restoring it to the socket. Dr. 
Mitchell, incognito, confronted the man. "May I ask," Mitchell 
said, "what anesthetic you used?" "I can hardly explain that to 
you," the quack replied, "you wouldn't understand; but I can tell 
you that it's shaped something like a spoon." 10 Few physician critics 
of quackery, however, placed it within a broader social and intellec- 
tual setting. 

Historians had now and then considered proprietary pills and 
potions as one aspect of another larger theme, for example, Thomas 

9. James Harvey Young, "The Hadacol Phenomenon," Emory University Quar- 
terly, 1951, 7:72-86. 

10. M. G. Selig, "Quacks and Quackery," Journal of the Mount Sinai Hospital, 
1938,4:673. 



62 



James Harvey Young 



D. Clark's shrewd observations about nostrums sold in country 
stores and advertised in country newspapers. 11 Very little, however, 
had been written either by popular or academic historians in which 
quackery held center stage, and most of this neglected quackery's 
sobering features, instead focusing on the colorful, the amusing, and 
the bizarre. For me, too, quackery's outrageous excesses possessed a 
morbid fascination, and I desired to exploit them, but I mainly 
intended to explain the grievous impositions quackery places upon 
society's well-being. Thus my sense of mission in writing The Toad- 
stool Millionaires and The Medical Messiahs. 12 

Here, besides telling my own tale, I want to suggest how narra- 
tive plays a part in my writing about quackery. This probably was 
a natural response to the fact that narrative has always been a 
fundamental ingredient in nostrum promotion. In the explosion of 
quackery in early modern Europe, Grete de Francesco has observed, 
charlatans "were far from unaware of the need of mankind for 
connected stories," and so they told such tales from platform or in 
print, "in order to make sales." 13 This tradition persisted. The prod- 
uct is presented as a unique all-powerful curative agent. Whence 
has this wonder come? 14 Did a missionary bring the secret back 
from the jungles of darkest Africa? Was the formula recorded in 
hieroglyphics on a papyrus scroll found under the mummified head 
of an Egyptian pharaoh? Was the secret pried despite great peril 
from a remote tribe of Native Americans? Figure 8 shows the cover 
of a dime-novel-length pamphlet advertising Judson's Mountain 
Herb Pills. 15 The formula was purportedly acquired by a Dr. Cunard 
from an Aztec sachem as reward for rescuing his daughter Tula 
from the clutches of the savage Navajos. 

Much of what we know about many major patent medicine 
proprietors, indeed, comes from highly fictionalized accounts, pre- 
pared for promotional purposes, of how they got started in the 



11. Thomas D. Clark, Pills, Petticoats, and Plows: The Southern Country 
Store (Indianapolis, Ind.: Bobbs-Merrill, 1944) and The Southern Country Editor 
(Indianapolis, Ind.: Bobbs-Merrill, 1948). 

12. James Harvey Young, The Toadstool Millionaires: A Social History of 
Patent Medicines before Federal Regulation (Princeton, N.J.: Princeton University 
Press, 1961) and The Medical Messiahs: A Social History of Health Quackery in 
Twentieth -Century America (Princeton, N.J.: Princeton University Press, 1967). 

13. Grete de Francesco, The Power of the Charlatan (New Haven, Conn.: Yale 
University Press, 1939), pp. 128 and 131-132. 

14. Young, Toadstool Millionaires, pp. 173-180. 

15. Anonymous, The Rescue of Tula (New York: B. L. Judson, 1859). 



Pursuing Health Deception 



63 




Figure 8. Title page of a promotional pamphlet imitating the dime novel 
genre for one of the numerous nostrums trafficking on their asserted Native 
American origins. 

From the Collection of the Library of Congress. 



64 



James Harvey Young 



business. So far as I am aware, the only well-known proprietary 
concern that has turned its documentary files over to an archives 
for researchers to consult is the Lydia E. Pinkham Medicine Com- 
pany. Upon its dissolution, while selling the right to make the Vege- 
table Compound to another company, the Pinkham concern gave 
its records to the Arthur and Elizabeth Schlesinger Library on the 
History of Women in America at Radcliffe College. 16 Withheld 
from the gift and destroyed were thousands of letters written to 
Lydia and her successors from women seeking health counsel, letters 
Lydia had promised in her advertising would never be seen by the 
eyes of men. 

In The Toadstool Millionaires I used case histories to help make 
lucid and vivid certain facets of the nostrum racket. I told stories 
of Thomas Dvott (see Fig. 9) and William Swaim (see Fig. 10) of 
Philadelphia in presenting the first period — the 1820s — in which 
the evils of patent medicines received extensive criticism. I re- 
counted the career of Benjamin Brandreth and his Vegetable Univer- 
sal Pills in explaining the tangled interactions between the 
proprietary business and the press. I narrated the adventures of 
David Hostetter and his Bitters in elucidating that class of reading 
matter, next to the Bible, most universally found in American 
homes, the patent medicine almanac (see Fig. 11). And I used Wil- 
liam Radam and his bottled Microbe Killer to show how even such 
a stellar scientific concept as the germ theory could be torn from 
context and twisted to the profit of the quack. 

Likewise, in The Medical Messiahs I told stories to help make 
my points compellingly. Marmola meant weight-reduction fraud; 
Ruth Drown's Radio Therapeutic Instrument, device deception; 
Adolphus Hohensee, nutrition nonsense; Harry Hoxsey, cancer 
quackery; the Kaadt brothers, diabetes deviltry. 

The striving for food and drug laws and the coming of regula- 
tion brought an advantage to the historical story-teller that he had 
not enjoyed in describing earlier times. Up to this point, the novelist 
had held a monopoly of direct discourse, the product of his imagina- 
tion. Now Congressional committee hearings reproduced verbatim 
the give and take of query and answer. The Congressional Record, 
although "corrected" slightly in proof to modify what was really 

16. Conversation with Diane M. Dorsey, archivist, The Arthur and Elizabeth 
Schlesinger Library on the History of Women in America, Radcliffe College, Cam- 
bridge, Massachusetts, 8 October 1971; Eva Mosely, curator of manuscripts, Schle- 
singer Library, to author, 18 February 1975. 



Pursuing Health Deception 




APPROVED 

FAMILY MEDICINES. 

Which are celebrated/or the care of most d seases xvhich the human body, is liable; 
PREPARED ONLY BY 1 HE SOLE PROPRIETOR, 

T. W. DYOTT, M. R 

GRANDSON OF THE LATE CELE ABATED DR. ROBERTSON of Edinburgh, 
And for sale in Philadelphia, only at the [ n.ijrietoi's whole*ale and retail 

Drug and Family Medicine Warehouse, 

No, 137 and 139, Ntrth Eaet corner ot Second and Race SttetU. 

Figure 9. From his Philadelphia warehouse, Thomas W. Dyott sent by 
Conestoga wagon a wide assortment of his proprietary medicines to all 
sections of the nation. 

From the Aurora General Advertiser, Philadelphia, 3 January 1821, in the Collections of the 
Library of Congress. 

said, provided often powerful oratory and sharp exchange. The 
transcript of record of trials in federal district courts contained 
the words truly spoken by lawyers, witnesses, and judges. These 
transcripts are sometimes available for cases ruled on by the Su- 
preme Court in that august body's library, and some transcripts of 
cases not appealed form part of the case jackets in the Food and 
Drug Administration (FDA) archives. Excerpts from such direct 
discourse cited in historical writing can give a sense of immediacy, 
provide an interlude of drama, catch atmosphere, and enhance 
meaning. 

At a trial in Indiana during 1948, Leonard, a diabetic boy of 
13, is testifying as to advice given him two years before at a clinic 
in South Whitley run by two elderly physicians, the Kaadt brothers 



66 



James Harvey Young 



SWAIM'S PANACEA, 




For the cure of Scrofula, or Km,,/s Evil, Ulcers, 
Rheumatism, Syphilitic, VlereuriH.I and Liver 
Co» pi lints, and most D seases arising in de- 
bilJat* «i constitutions, or irouj an impure state 
of the Biood, &c. &c. 

This Medicine has acquired a very extended and 
established celebrity both in hospital and private 
practice, which its efficacy alone has supported up 
wards of eight y ears 

Figure 10. In a neoclassic period, William Swaim of Philadelphia chose 
Hercules as the symbol of the conquering powers of his Panacea over the 
Hydra-like multiplicity of disease. 

From the Democratic Press, Philadelphia, 28 April 1827, in the Collections of the Library of 
Congress. 



Pursuing Health Deception 



67 





J.JL 



ILLUSTRATED 



B&If SB SflflS 

ALMANAC 

is e 




FOR MERCHANTS, MECHANICS, MINERS, 

ngaas f iuiiiifi 

AND GENERAL FAMILY USE. 

Carefully calculated for such Meridians and Latitudes as are best suited for 
a Universal Calendar for the United States. 

'^^^ 

PUBLISHED BY HOSTETTER & SMITH, 

PITTSBURGH, PA. 



ir ■ ■■■■■■■ ■■■■ 1 1 , i ■ . i . i vi ■ rvr, iVi"i;I 



Figure 11. Hostetter's Bitters was an 80-proof patent medicine whose 
Pittsburgh proprietors for decades furnished almanacs in many languages 
to the diverse American populace. 

From the author's collection. 



68 



James Harvey Young 



DUPING THE DIABETIC 



THERE IS NO "PATENT MEDICINE" THAT WILL CURE 
DIABETES. PRACTICALLY ALL NOSTRUMS SOLD FOR 
DIABETES AGGRAVATE THE DISEASE; NEARLY ALL OF 
THEM ARE KIDNEY IRRITANTS. 



HERE ARE A FEW ALLEGED REMEDIES 
FOR DIABETES: 

BANBAR DtABETYLIN KELPE KOE 

BAUER'S ANTIDi ABETICUV DILL'S DIABETIC MIXTURE PANCRETONE 

BETO fc K. TABLETS iEKSIPi SAL S A NO 

MARIE CARR FRAUD FLOWERING HERB SANBORN TREATMENT 

DIABESAN INSOLOID UVURSIN 

DIABETICiNE JAMUN COMPOUND V IN DOR DIABETIC WINE 

CM A BET OL KAADT TREATMENT WARNERS SAFE DIABETES REMEDY 



NOT ONE OF THESE EVER CURED A CASE OF DIABETES! 



Figure 12. Diabetes quackery ran rampant both before and after the 
discovery of insulin treatment. 

Poster listed in an American Medical Association catalog, Material Prepared and Issued by the 
Bureau of Investigation of the American Medical Association (Chicago, 111.: AMA, circa 1940). 



(see Fig. 12). 17 Leonard had taken rough notes at the time, and now 
he is asked to read them to the court. 

"Honey is best," he reads. "You can ... eat all you want .... 
Boiled sugar is safe .... You can drink whiskey .... It is 
good for diabetes .... Smoking does not affect diabetes in 
any way .... Insulin is cause of bloating .... Not due to 
pancreas .... Not due to shock .... You should always have 
sugar in urine." 

"Read that again," the district attorney requests. 



17. Young, Medical Messiahs, pp. 217-238; Transcript of Record in the United 
States Circuit Court of Appeals for the Seventh Circuit, No. 961 7, The United States 
of America, Plaintiff-Appellee, vs. Dr. Charles F. Kaadt, Defendant-Appellant; No. 
9618, The United States of America, Plaintiff- Appellee, vs. Dr. Peter S. Kaadt, 
Defendant-Appellant; Appeals from the District Court of the United States for the 
Northern District of Indiana, Fort Wayne Division (Indianapolis, Ind., 1948). 



Pursuing Health Deception 



69 



"You should always have sugar in urine . . . ," the boy 
complies. "Do not ever get [a] blood sugar [test], it is dangerous 
.... The less insulin, the better . . . . " 

The boy's mother follows him to the witness chair. Getting home 
from the clinic, she says, the boy had curtailed his insulin and 
abandoned his diet. Soon, at a birthday party, he had eaten ice 
cream and cake. 

"In the morning," the mother testifies, "I went to call Leonard 
for school and he appeared lazy and did not care to get up." 

"What did you do then?" the government attorney 
prompts. 

"I thought I would get him a glass of milk, and he began 
to throw up, and went back to lie down .... In the afternoon 
he seemed more lazy and in a stupor, sort of .... He was 
flushed .... He began to breathe heavy, and just then, when 
my husband came, he said, 'Call his doctor.' " 

"I said no, no, because he is taking this treatment [a 
vinegar-saltpeter mix] he is supposed to have some kind of 
reaction." 

But at one o'clock that night, the parents took their son to the 
hospital. 

"Is Leonard taking the Kaadt treatment today?" the district 
attorney asks. 
"No." 

"Is he taking insulin today?" 
"Yes, sir." 

"How is he getting along today?" 

"Wonderful. He is growing fast. He is brilliant in school." 

Each of the doctor brothers was fined $7,000 and sent to prison 
for four years. 

The discouraging aspect of quackery, of course, is that similar 
sad stories can still be told, that health deception demands continu- 
ing pursuit. In the year I finished writing The Medical Messiahs, 
1966, an informed official, guessing at the annual bill for our na- 
tion's quackery, put the sum at two billion dollars. 18 Last year, as I 
was drafting an update chapter for a new paperback edition of the 
book to be published in spring 1992, the best guess of another 



18. Young, Medical Messiahs, p. vii. 



70 



James Harvey Young 



expert for the current toll was 28 billion, 19 and I have seen 30 
billion since. 

In the cancer field, the most complex tale concerns the rise and 
fall — but not the demise — of Laetrile. 20 The cyanide-containing 
compound was first marketed as a chemotherapeutic agent, then as 
a new vitamin, finally as the crown jewel in a regal diadem of 
multiple therapies. It gained a dozen years of legal importation and 
interstate distribution through the decision of one federal district 
judge, finally ended as the result of Supreme Court action. Laetrile, 
furthermore, won some kind of special status in half the states as 
a result of high-pressure lobbying by ardent support organizations 
waving the "freedom of medical choice" banner. This pressure grew 
so great that the Congressionally enacted and Supreme Court ap- 
proved legal system of new drug approval, by which a drug's spon- 
sor is responsible for undertaking the tests demonstrating safety 
and effectiveness, became short-circuited. Instead, the National In- 
stitutes of Health felt it necessary to conduct clinical trials. These 
demonstrated that Laetrile was not effective for treating cancer 
and that its cyanide content posed hazards. Laetrile, like several 
preceding unorthodoxies that had had their time in vogue, may still 
be secured in Mexico, and, I understand, may be ordered in the 
United States by phone. When AIDS surfaced a decade ago as a 
devastating disease, Laetrile, like other discredited cancer treat- 
ments, was ballyhooed as a cure. 

With respect to AIDS, no single specious treatment has assumed 
the dominant place that Laetrile once held among cancer unortho- 
doxies. Instead, the number of quack options has been legion (see 
Fig. 13). 21 Substances proffered for injection into the body alone 
have included amino acids, blood serum, cells from fetal animals, 
Easter lily bulbs, hydrogen peroxide, ozone, polio vaccine, pond 
scum, snake venom, vitamins, and the sufferer's own filtered urine. 
Moreover, with medicines of proven effectiveness in treating AIDS 
and its attendant afflictions so very few, a wide range of unproven 



19. James A. Lowell and Alison E. Lowell, Quackery and the Elderly (New 
York: American Council on Science and Health, 1990), p. 1. 

20. James Harvey Young, "Laetrile in Historical Perspective," in Gerald E. 
Markle and James C. Petersen, eds., Politics, Science, and Cancer: The Laetrile 
Phenomenon (Boulder, Colo.: Westview Press, 1980), pp. 1 1-60. An updated version 
of this chapter will be included in James Harvey Young, American Health Quackery: 
Collected Essays (Princeton, N.J.: Princeton University Press, 1992). 

21. This paragraph on unproven treatments for AIDS uses material from a 
chapter on this theme in American Health Quackery. 



Pursuing Health Deception 



71 



Anti-AIDS Pill 

Available Without A Prescription! 

Figure 13. Fear of AIDS spawned scores of nostrums and devices promis- 
ing prevention and cure. 

Courtesy of the Food and Drug Administration. 

medications has been resorted to quickly, a few later proving of 
value, some a disaster, many not yet fully evaluated. One example 
of this type is dextran sulfate, a drug that had been sold over- 
the-counter in Japan for two decades to thin blood and control 
cholesterol. 

In 1986 this drug was shown to stop the spread of the HIV 
virus between cells during in-vitro tests, so a small clinical trial was 
launched and larger ones scheduled. The untested drug began to 
pour into the AIDS underground. It "was carried by flight atten- 
dants," a reporter wrote, "mailed by American expatriates living in 
Tokyo and smuggled across the border from Mexico." 22 Shady 
entrepreneurs made huge single purchases in Japan and mailed dex- 
tran sulfate across the Pacific in packages marked "tea sets" and 
"Japanese dolls." As this widespread underground use of the drug 
continued, the FDA eased its official policy on the importation of 
unapproved medications by patients wishing to use the drugs solely 
for their own treatment under the guidance of physicians. The 
policy also permitted the importation by mail of such personal use 
quotas. This was one of a number of steps the FDA had begun 
to take, under the combined influence of the Reagan-Bush anti- 
regulatory attitude and of AIDS organization pressure, to speed up 
the new drug testing process and to authorize earlier use of drugs 
still under study by patients with life-threatening diseases. These 



22. Joshua Hammer, "Inside the Illegal AIDS Drug Trade," Newsweek, 15 
August 1988, pp. 41-42. 




72 



James Harvey Young 



relaxations of the rules precipitated a sharp debate among medical 
scientists, but the trend toward speedier access to new drugs contin- 
ues. Preliminary data from the dextran sulfate clinical trials seemed 
to show that it was not sufficiently absorbed into the bloodstream 
to make it likely that the drug could protect the infection-fighting 
white blood cells against the HIV virus. It looked as if another 
hope might fail. Underground use of the drug, however, I was told 
recently at the FDA, continues. 

Stories continue to contest against stories. The tales told by 
quacks seek to make their shady therapies sound plausible to the 
public. A host of unorthodox practitioners, as two philosophers 
assert, are striving to develop a counterparadigm espousing pseudo- 
science, making its health concepts appear more true, effective, 
and appealing than the tenets of scientific medicine. 23 And, as a 
sociologist has observed, "the fate of medical social movements is 
not determined by the soundness of their theories or the effective- 
ness of their therapies, but by their ability to mobilize political 
and social resources effectively." 24 The near-success of the Laetrile 
campaign reveals that those who believe in scientific medicine con- 
stantly confront a risk of losing. With so much at hazard, those 
dedicated to the cause of science and reason must continue to tell 
their stories. 

272 Heaton Park Drive 
Decatur, GA 30030 



23. Clark Glymour and Douglas Stalker, "Engineers, Cranks, Physicians, Magi- 
cians," New England Journal of Medicine, 1983, 308:960-964. 

24. Marcine J. Cohen, "Medical Social Movements in the United States 
( 1 820-1 982) : The Case of Osteopathy" (Ph.D. dissertation, University of California, 
San Diego, 1983), p. xii. 



James W. Kennedy, M.D., 
and the Joseph Price Memorial Hospital: 
Recollections 

FREDERICK MURTAGH 

It was my good fortune in 1942 to spend my senior year in medical 
school as an intern at the Joseph Price Hospital, a 50-bed private 
hospital in Philadelphia founded by Dr. Joseph Price in 1891. 

Price was an 1877 graduate of the University of Pennsylvania 
Medical School. He gained eminence through his work at the Phila- 
delphia dispensary and the Preston Retreat, where he established 
services in obstetrics and gynecology, and developed the techniques 
for abdominal and gynecological surgery. Known as a great clinical 
teacher, he was considered by many to be the father of abdominal 
surgery in America, although he never held an academic appoint- 
ment in a medical school. A tireless worker, he believed strongly in 
aseptic techniques at a time when many of his fellow physicians did 
not. He was also an outspoken, controversial figure who sometimes 
severely criticized his colleagues. 

In 1891, Price established his own private hospital at 241 
North Eighteenth Street, in Philadelphia. All patients were treated 
regardless of race, creed, color, or financial means. He disdained 
financial support from other institutions or from local or state gov- 
ernments, knowing that if it was once accepted, he would no longer 
be in complete charge. In his hospital he was visited regularly by 
outstanding surgeons from around the world who wanted to learn 
the techniques of abdominal and perineal surgery. For many years, 
annual visits were made by the Mayo brothers. 

Dr. James W. Kennedy, a native of Kansas and an 1899 gradu- 
ate of the Jefferson Medical College, joined Price in his practice 
around the turn of the century. Kennedy worked with him for 11 
years and, at the time of Price's death in 1911 became his profes- 
sional heir. Kennedy acquired the hospital and became neurosurg- 
eon-in-chief, a position he still held in 1942, the year that I was 
there. He was by then 70 years of age, had been practicing for over 
40 years, and was not only the student of Joseph Price, but his 
absolute disciple. Kennedy always spoke of his predecessor in the 
present tense as though Price were about to pop in at any moment. 

73 

Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 73-82 
© 1992 by The College of Physicians of Philadelphia. 



74 



Frederick Murtagh 



Each year Kennedy took two senior medical students into the 
Joseph Price Hospital as interns, providing them with room and 
board. They in turn functioned as house officers, working up the 
patients as they were admitted, and looking after them on nights 
and weekends. Theoretically, the medical students were supposed 
to attend classes during the day, but they frequently stayed at the 
hospital to help with the surgery instead. It was a pure, pre-Flexner 
sort of arrangement. No financial consideration was offered, nor 
was it expected. When I had the position, I was only too happy for 
the opportunity to be in close contact with patients and also to be 
on a one-to-one basis with an experienced surgeon. Later, I was 
greatly disturbed to find that my successors demanded to be paid 
money for this experience. To me, this was the first crack in the 
dignity of the profession and has led to its deterioration. 

It was under these circumstances that Jackson Dunning, from 
the University of Pennsylvania, and I, from Temple University, en- 
tered the Joseph Price Hospital at the beginning of our senior year 
in May 1942 (see Fig. 1). 

The hospital was housed in two large, adjoining four-storey 
brownstone mansions. A massive bay window fronted each of the 
houses, bracketing a common entrance at the top of six granite 
steps guarded by two high oak doors with beveled glass panels. 
Walking through these doors was like stepping back 25 years into 
the past. 

The two houses had been broken through at every level to 
make one building with all patient care activities housed on the 
north side and facilities for support services and a nursing school 
on the south side. Examining rooms throughout the hospital were 
furnished in much the same manner: plain metal furniture painted 
white, with an examining table, a glass-door cabinet for instru- 
ments, a small table with a sterilizer, and a writing desk and chair. 
The floors were tile and the entire room painted white. 

On the first floor, a long hall toward the back of the hospital 
led past utility rooms, single occupancy patient rooms, a nursing 
station and, at the very back, a four-bed "ward." All floors were 
bare, walls and wood work were painted white, and the rooms were 
furnished with iron beds, a small bedside stand with a lamp, and a 
single chair. One overhead light with a glass shade hung from the 
ceiling in each room. There were shades on each of the windows, 
but no drapes — all in the name of cleanliness and sterility. Bath- 
rooms were really considered unnecessary because most patients 



Price Memorial Hospital 



75 




Figure 1. Frederick Murtagh, James W. Kennedy, and Jackson Dunning, 
1942, Joseph Price Hospital, Philadelphia, Pennsylvania. 

Courtesy of Dr. Frederick Murtagh. 



were kept strictly in bed, their needs attended to by the nurses. The 
second and third floors contained mostly patients' rooms, all of 
them single occupancy and starkly furnished to provide only the 
most basic needs for patient care. 

The fourth floor contained quarters for the interns in the front 
on the Eighteenth Street side. Just past a stairwell was a labor room 
containing a single bed, a chair, a cabinet for supplies and a scrub 
sink. A wide doorway led into the adjacent delivery room, which 
was slightly larger than the labor room and contained two scrub 
sinks against the front wall. Perpendicular to the back wall stood the 
delivery table, with a breakaway section which could be removed at 



76 



Frederick Murtagh 



the time of delivery. There was a cabinet for supplies and medica- 
tions and one or two rolling metal stands to hold instruments. The 
next room back was an anteroom to the main operating room. This 
room contained two large autoclaves, metal cabinets for the storage 
of instruments, supply cabinets, and work tables for putting up 
instrument packages and linens. On the north side of the room were 
two scrub sinks. In spite of its general use for sterilization purposes, 
this was known as the "dirty room," because the surgeons' scrub 
ritual began here in the two "dirty" sinks, before moving to the 
main operating room, where the ritual continued through four 
"clean" sinks. 

The main operating room extended across the back of the 
building and measured approximately 20 by 30 feet. Entrance was 
through a doorway from the preparation room or directly from the 
hallway. This room had a blazing bright white appearance with a 
smooth tile floor and the three walls and ceiling all painted white. 
The back wall facing east was all paned glass which admitted the 
light of the morning sun as it rose over the Seventeenth Street 
rooftops. The operating table was painted metal. Its head could be 
elevated and its foot could be dropped down to place the patient in 
the lithotomy position. Wheeled tables held the instruments, 
wheeled stands held basins of fluid such as alcohol and carbolic 
acid solution, a straight chair was available for the surgeon to 
sit on, and a stool for the anesthetist, but there were no other 
furnishings. 

Mounted on the north wall of the operating room was a large 
board which looked like an oversized ironing board. On it were 
painted the words "Honor to Whom Honor is Due." This piece of 
equipment was said to be Price's original operating table. During 
his career, Price had not only operated at the Preston Retreat and 
the Philadelphia dispensary, as well as at many other hospitals, but 
he had also traveled to rural areas and performed surgery on pa- 
tients in their own kitchens. He carried this "ironing board" with 
him wherever he went and used it as his operating table, placing it 
on top of kitchen tables. 

Until the 1930s, the Joseph Price Hospital had supported a 
diploma school of nursing. The school had turned out some of the 
Philadelphia area's best nurses, all of whom were very much in 
demand by most of the local and regional hospitals. In 1942, when 
I worked there, the corps of nurses functioning in the hospital were 
graduates of this earlier program and most of them lived in the 



Price Memorial Hospital 



77 



hospital. The right side of the building, or the south house, was 
originally designed to support the nursing school and to provide 
accommodation for live-in nurses and employees of the hospital. 
On the first floor in the front there was a formal parlor elaborately 
furnished with oriental rugs, damask draperies, and early twentieth- 
century furniture. This room was used for receptions, for gradua- 
tions of the nursing classes, for live-in persons to entertain friends, 
and for general social functions. It was also a waiting room where 
patients' families could gather and be counseled. 

A dining room behind the parlor accommodated about 35 
persons. Behind this was the kitchen. Off to the left in this area was 
the X-ray room and behind that the laboratory, where blood counts, 
chemistries, and the preparation of pathological specimens were 
done. The second, third, and fourth floors of this part of the hospital 
were not openly connected with the other building, but were cut 
through with closed doors which could be locked. This area con- 
tained mostly domestic quarters for the live-in nurses or other sup- 
port personnel such as the dietitian, laboratory technicians, and so 
on. It also contained classrooms and dormitories for the former 
school of nursing. 

Dr. Kennedy was absolute patriarch of this small domain. He 
was a tall, thin, Lincolnesque person with crisp, clean-shaven, angu- 
lar features, and large powerful hands. At the age of 70, he was in 
perfect physical condition. The man looked as though he had spent 
all of his life on the Kansas plains rather than in a surgical operating 
room. He was precise in all of his activities — never a wasted 
movement. He lived at the Embassy Apartments at Eighteenth and 
Spruce Streets with his wife Jean, and walked to the hospital each 
morning. With long, measured strides he would enter the building 
through a rear doorway. At the very moment he strode into the 
reception room, the grandfather clock would bong the hour of 
eight, announcing to the entire institution that Kennedy was in the 
house. The whole place snapped to attention. 

Kennedy was greatly revered and at the same time feared. He 
was affectionately known as "Pap" to the nursing staff and the 
byword around the hospital was "Jesus Christ, Joseph Price, and 
Dr. Kennedy," but he was always addressed directly as "Dr. Ken- 
nedy." He was a quiet, gentle person in contrast to Joseph Price, 
and not as outspoken as his mentor. At the same time, he was not 
above criticizing his colleagues in private conversation, but never 
publicly or in writing. When mistakes were made in hospital mat- 



78 



Frederick Murtagh 



ters, however, he had no difficulty expressing his displeasure. For 
recreation, he liked to putter around his small farm in Mantua, 
New Jersey. His favorite diversion was a trip to Kansas to shoot 
jackrabbits, and he would always bring back several pairs of rabbit's 
ears as testimony of his skill with a 22-caliber rifle. 

Professionally, Kennedy was the true disciple of Price and fol- 
lowed Price's teaching, philosophy, and techniques to the letter. 
Kennedy made minor concessions to "modern medicine," such as 
wearing surgical gloves to operate, but only if there were visiting 
firemen in the operating room. He preferred to operate bare-handed 
after a meticulous 45-minute scrub in a series of scalded sinks and 
a basin of sterile water. He claimed the use of gloves dulled his 
surgical "touch," was traumatizing to tissues, and, in general, 
robbed the surgeon of his aseptic consciousness. 

All diagnoses were made on clinical evidence alone; Kennedy 
quietly listened to the patient's complaints and symptoms, all the 
while appraising the patient visually — assessing apparent age, state 
of nutrition, skin color and turgor, the facies, and level of physical 
distress. He then usually put a hand on the patient's brow, looked 
at the conjunctiva, put a finger on the pulse, and finally, a hand 
on the abdomen and, if necessary, made an internal examination. 
Kennedy might get a blood count or a chest X-ray for the record 
but only to demonstrate his recognition of contemporary means of 
clinching a diagnosis. 

Kennedy's surgery was swift and precise, without a wasted 
motion. In abdominal operations, he rarely used mechanical retrac- 
tors, preferring that his assistant use his hands for that purpose. 
Intestinal anastomoses were accomplished with a Murphy button 
and he did gastric resections with straight clamps and over-sewing, 
all in a very crisp manner. No matter what the problem, we were 
never at the operating table for more than 45 minutes. Closures 
were made with hand-held straight needles through all layers of the 
abdomen with silkworm gut secured with lead shot. 

At the time I was at the Joseph Price Hospital, Dr. Peter Marvel 
provided the medical back-up. He was the classic example of the 
kind and gentle family physician who delivered babies, made 
housecalls, had an intense interest in his patients, and was a foun- 
tainhead of practical knowledge and information. Dr. Mary Hippie, 
a solid woman bucking a man's world, also provided excellent 
medical back-up and Dr. Robert Shoemaker, a radiologist, would 
stop in almost daily to interpret the few films that were taken. 



Price Memorial Hospital 



79 



In 1942, two physicians, Dr. William T. Lemmon, and his 
associate Dr. Emma Bevan, in their operations represented the state- 
of-the-art approaches to surgical problems in Philadelphia. They 
practiced together mostly at Thomas Jefferson Medical College, but 
frequently sent patients to the Joseph Price Hospital. "Wild Bill" 
Lemmon, as he was known, was an ecumenical surgeon who could 
and did cover the surgical field. I recall helping him with a vaginal 
repair on a patient and afterwards, while we were dressing, he asked 
what Dr. Temple Fay, at Temple University, was doing about brain 
tumors because he had to go over to Jefferson and operate on a 
meningioma. Lemmon had developed the technique of continuous 
spinal anesthesia and, of course, used it in most of his cases. Dr. 
Bevan was especially helpful to me and let me do many of her 
obstetrical cases. Kennedy welcomed these doctors to the Price 
Hospital, but was often privately critical of their methods, which 
he considered to be departures from the basic concepts of surgical 
practice. 

The nurses at the Joseph Price Hospital were professionals, 
trained from the first day in the hospital's own diploma school of 
nursing to take care of patients. A few of the younger nurses in 
1942 had come from other training programs, but they were quickly 
indoctrinated in the principles of primary patient care at the Price 
Hospital. I never saw a nurse on duty who was not starched and 
primed to the nines. Their hair was always carefully pinned up and 
they wore no make-up, jewelry, or fingernail polish that might 
spread contamination. They stood at attention when a doctor en- 
tered the room, could answer any questions regarding the patient's 
condition, and would carry out verbal or written orders promptly 
and efficiently. The nurses could perform enemas, catheterize pa- 
tients, give injections, dress wounds, allay a patient's fears and anxi- 
eties and, if necessary, give a turpentine stupe (the poultice-like 
application of a towel soaked in a heated, diluted turpentine solu- 
tion, applied to the abdomen) to a patient with abdominal disten- 
sion. A patient never had a wrinkled or soiled bed, nor did a patient 
have to wait more than a few minutes for a response to a call for 
help at any time of the day or night. On a cold night, the nurses 
saw that the sheets were warmed by a bed warmer, and if it was 
particularly cold, a brick heated in the kitchen stove and wrapped 
in heavy towels was placed by them at the foot of the patients' beds. 

The most frequently performed surgical procedure at the Jo- 
seph Price Hospital was vaginal hysterectomy utilizing the Pryor 



80 



Frederick Murtagh 



clamps, a technique developed by Price. He claimed to have per- 
formed more than four thousand such procedures during his career 
and, of course, Kennedy continued the work. Both surgeons were 
sometimes criticized by their colleagues for what were considered 
to be marginal indications for the procedure. The Price-Kennedy 
concept was that the uterus, after the child-bearing period, was a 
vestigial organ and the nidus of cancer. The two surgeons believed it 
was better removed if there was the slightest indication of problems 
provided it could be done quickly, easily, and with little risk to 
the patient. Price and Kennedy could do just that. Their average 
operating time for an uncomplicated vaginal hysterectomy was 
about six minutes. A complicated case in which the patient had 
fibroids or other pathology might take as long as 15 or 20 minutes. 
Morbidity and mortality from these operations was extremely low. 
From my own observation in 1942, out of a number of cases I 
helped with during that year, I know of no deaths and can remember 
only one infection. 

Preparation for such a procedure usually began before daylight. 
Lydia Miller, chief operating room nurse, timed her "setting up" so 
the surgery could begin shortly after sunrise, when light poured 
through the operating room windows to illuminate the operative 
field. Dr. Harold Roxby from Swarthmore usually came in to assist 
at these procedures. 

There was a real pecking order to the scrub ritual. Kennedy 
went first, followed by Roxby, and then myself as the three major 
participants. The nurses had scrubbed long before. Washing and 
hand scrubbing for the surgeons began in the "dirty room," with a 
timed five-minute scrub at each sink with a hard bristle brush and 
Ivory soap. The surgeons then advanced to the operating room and 
scrubbed through four scrub sinks. These sinks and the fixtures 
would be washed down with scalding hot water to ensure their 
sterility — a different sterile brush and piece of soap were used at 
each sink. Five minutes more scrubbing in each of these four sinks 
was followed by a five-minute scrub in alcohol and then a final 
rinsing of the hands in sterile water. This would be followed by the 
donning of white sterile gowns and gloves. 

In the meantime, the patient had been set up and anesthetized. 
Anesthesia was by open drop ether administered by whomever hap- 
pened to be standing around and apparently not doing anything. 
This could be a visiting professor, a stray medical student, the 
patient's referring physician, or a nurse. The anesthesia, of course, 



Price Memorial Hospital 



81 



was completely under the direction of James Kennedy. His instruc- 
tions to the anesthetist were to place an oversized, gauze-covered 
kitchen tea strainer over the patient's nose and mouth and liberally 
to pour ether directly from the can onto the mask. The anesthetist 
kept a finger under the angle of the patient's jaw to keep her from 
"swallowing her tongue," and when she was breathing easily and 
regularly the ether administration would be cut down to a mainte- 
nance level for the remainder of the operation. 

There was rarely any kind of intravenous line running to the 
patient. There might be a blood pressure cuff on the patient during 
the operation, but the pressure was rarely taken. The level of anes- 
thesia was determined simply by monitoring the patient's pulse, 
respiratory rate, and pupils of the eyes. Every once in a while 
during the operation, Kennedy would look up and inquire about the 
patient's condition and, when he was finished, he would simply 
stand up and say, "O.K., throw it away," meaning to throw away 
the ether. Usually the patient awakened in a few minutes with or 
without the help of some oxygen. For all operative procedures, even 
a simple appendectomy, the patient was kept in bed for a minimum 
of five days and often for as long as two weeks. I have no recollec- 
tion of any patient developing pulmonary complications or 
thrombophlebitis. 

Simple mastectomy was Kennedy's procedure of choice for 
carcinoma of the breast, usually with the removal of as much of 
the "cancer" as he could see grossly. Since the choice of simple 
mastectomy over radical mastectomy is still a controversial issue, I 
would like to know where Kennedy's records are, because he did a 
number of these operations. I am not aware that there has ever 
been a follow-up of these cases. 

All doctors who referred patients to the Joseph Price Hospital 
did obstetrics and I participated in a significant number of deliveries 
assisting others and also did a number of them myself, particularly 
on weekends, when the attending physician was unavailable. Deliv- 
eries were made with the help of a little nitrous oxide for the mother 
and again any repairs necessary were made with straight needle and 
silkworm gut secured with lead shot. Dr. Thaddeus Montgomery 
was professor of obstetrics at Temple University at that time, and 
my experience at the Joseph Price Hospital was sufficient for him to 
agree that my work there qualified as my senior obstetrics rotation. 

My graduation from medical school on 16 March 1943 ended 
this phase of my relationship with the Joseph Price Hospital. Fortu- 



82 



Frederick Murtagh 



nately, I was able to continue it for a period in 1946—1947. My 
early impressions of pure professionalism in medicine, the dignity 
of the profession, a direct, no nonsense approach to problems, and 
a sense of aseptic consciousness were the most valuable of my early 
years, and have supported me for the past 40 years of practice. 

Postscript 

On 15 May 1950, with the retirement of Kennedy, the Joseph Price 
Hospital closed its doors. It was eventually demolished to make 
way for the Vine Street Expressway. 

Department of Neurosurgery 
5 Silverstein Pavilion 
HUP 

3400 Spruce Street 
Philadelphia, PA 19104 



An Indescribable Feeling of Wretchedness: 
Letters to Samuel Jackson on Epilepsy 

JACK ECKERT 

Among the rich collections documenting the development of Ameri- 
can medicine held by the College of Physicians of Philadelphia is a 
recently catalogued cache of letters preserved by physician and 
educator Samuel Jackson. The letters are unusual because they con- 
cern nineteenth-century descriptions and treatments of a particular 
and then little-understood ailment — epilepsy — from the stand- 
point of both physician and patient. 

Jackson (1787-1872) received his M.D. from the University of 
Pennsylvania in 1808 and studied under James Hutchinson and 
Caspar Wistar. After a brief period in the family pharmaceutical 
business, he became a founder and trustee of the Philadelphia Col- 
lege of Pharmacy in 1821. He taught materia medica and pharmacy 
there until 1827, then began to teach physiology, assisting Nathaniel 
Chapman at the University of Pennsylvania. From 1835 until his 
retirement in 1863, Jackson held the professorship of the institutes 
of medicine at the University. He was an active Fellow of the College 
of Physicians and a member of the Philadelphia Medical Society 
and the Medical Society of the State of Pennsylvania. 

The collection contains over 20 letters, many of substantial 
length, dating from 1839 to 1860. These letters, written by a num- 
ber of physicians who were, almost exclusively, graduates of the 
University of Pennsylvania practicing in the southern United States, 
contain meticulous observations of the case histories, symptoms, 
and treatments employed in their epilepsy patients. The cases docu- 
ment the treatments and drugs generally prescribed as well as the 
uncertainty and fear attending the physicians as they confront an 
illness which they feel ill-equipped to handle. Possible theories for 
the cause of epilepsy and onset of its seizures are also evidenced in 
the letters; diet and climate are common explanations, and, interest- 
ingly, at least two of the physicians tied the epileptic seizures to 
phases of the moon. 

The letters addressed to Jackson ask for his advice on possible 
ways to treat the disease or eliminate the suffering of patients. It is 
notable that Jackson's former students continued to turn to him as 



83 



Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 83-100 
© 1992 by The College of Physicians of Philadelphia. 



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Jack Eckert 



an authority on the subject and, although often working on cases 
in consultation with local practitioners, call on the university profes- 
sor for assistance. Jackson's responses have, unfortunately, not sur- 
vived, though several letters refer to his prescribed regimen of diet, 
certain medications, such as nitrate of silver, and cold water 
bathing. 

Even more interesting are the letters written to Samuel Jackson 
by epileptics, as they use their own words to describe experiences 
with the affliction. It is rare, in primary source materials for the 
history of medicine, to gain an understanding of a disease from the 
inside, as it were. The patients use vivid, subjective phrases in their 
attempts to describe the sensations preceding a seizure, such as "the 
aura," "the glimmering before my eyes," "water rushing over a 
dam," and "an indescribable feeling of wretchedness." 

Fifteen of the twenty-two letters to Jackson in the collection, 
including letters from epileptics W. C. Haymond and A. F. Gregory 
and family members of epileptics, and case descriptions by physi- 
cians Richard D. Arnold, William B. Cochran, Francis H. Deane, 
Virginius W. Harrison, William B. Pleasants, John Thomas Pritner, 
John Seibert, George William McKenzie Semple, and Edmund P. 
Taliaferro, are transcribed here. The letters may raise more ques- 
tions than they answer. Why, for instance, are most of the letters 
from Southern practitioners? Why did Jackson keep them? And 
what advice did he give to both doctors and patients? Despite the 
questions, the letters shed light on the practice of medicine in the 
antebellum American South and the intellectual processes of obser- 
vation employed by physicians coping with a medical mystery. 1 

Letter 1. William B. Pleasants 2 to Samuel Jackson, Providence, Va., 8 
October 1839. 

Dear Sir: 

May I hope that you will pardon the liberty I have taken in earnestly 
soliciting your advice in a case which has caused the deepest anxiety on my 
part and baffled the skill of some most eminent practitioners. The case I 



1. For a discussion of the stigmatization of early twentieth-century epileptic 
patients and the work of the Craig Colony for Epileptics in New York, see Ellen 
Dwyer, "Stigma and Epilepsy," Transactions & Studies of the College of Physicians 
of Philadelphia, 1991, 13:387-410. 

2. William B. Pleasants, M.D. University of Pennsylvania, 1839, Virginia, 
practitioner. 



Letters on Epilepsy 



85 



allude to is one of epilepsy, in the person of my brother, aged 24 years. 
The history of the case is as follows, as far as I can collect the particulars. 

Early in the month of March last, he became very much heated and 
fatigued, in some project with his gun over a wood fire, and was discovered 
to have swooned or fainted; he, however, soon recovered and was appar- 
ently well for months afterward, but has since confessed that he had several 
successive intimations of an approaching syncope, or, rather, as he expresses 
it, an indescribable feeling of wretchedness, accompanied with almost total 
blindness for a short time. About the first of June last, after eating heartily 
at tea, of clabber & honey, and having just laid down, we were aroused 
by the cry that he was dying. I was summoned to his assistance immediately 
and found him completely convulsed. The contents of his stomach were 
soon thrown off, by an emetic first (or, I rather think, spontaneously) and an 
active cathartic administered forthwith. In 7 or 8 hours, however, another 
convulsion followed, and after a course of depletive & revulsive treatment, 
they were arrested for 8 or 10 weeks. Unfortunately, however, on one 
occasion, he overleaped the bounds of dietetic treatment which had been 
strictly enjoined & followed out till then, and the consequence was that 
another spell of paroxysms succeeded and have since recurred at intervals 
of 2 weeks and, perhaps a little remarkable, precisely at the change & full 
of the moon. 

I consulted Dr. Mettauer, 3 an eminent physician in Va., about the case. 
He put me upon the following treatment. Inasmuch as there was evidently 
existing great torpor of the liver and, consequently, pretty obstinate consti- 
pation, he advised the use of the nitro-muriatic bath over the region of that 
organ. Solution of aloes and potash, for the purpose of an aperient and 
also with a view of exciting the hemorrhoidal vessels of the rectum. The 
application of tartar emetic ointment to the dorsal spine, leeching & cup- 
ping the temples, as his condition required, and a strict adherence to a 
regulated diet — weak coffee in the morning with bran bread, soup for 
dinner, with a roasted Irish potato and a few stewed tomatoes, a cracker, 
& hot water tea for supper. His exercise has been regulated by his strength, 
and we have endeavored, in a word, to keep him from the influence of 
every thing calculated to excite or fatigue. In spite, however, of every 
attempt, he has had another attack of convulsions. Perhaps I should have 
mentioned that he is a man of middle stature, weighing about 140 lbs. 
while in health, and somewhat disposed to a plethoric condition of system, 
in other words, his system seems to possess considerable recuperative en- 
ergy, recovering rapidly after most powerful depletion. 

His condition now I cannot think (should he be attacked again) would 
possibly admit of farther depletive means with lancet. I have not ventured 
upon the class of nervine remedies and, in fact, feel greatly at a loss what 

3. Probably John Peter Mettauer (1787-1875), M.D. University of Pennsyl- 
vania, 1809, and a noted Virginia surgeon. 



86 



Jack Eckert 



to do, until I hear from you. Perhaps a most important item I have yet to 
notice; that is, his grandmother was a subject of epileptic paroxysms for a 
number of years, though finally died of another affection. 

From the facts I have collected about the case, I am under the impres- 
sion that they originate principally from gastric irritation and earnestly 
hope that they have no dependence or hereditary transmission. This your 
own skill must decide, as well as you can, from the hasty and unconnected 
history of the case. I do hope that you will kindly lend your advice to one 
who had the honor of listening to your instructive voice last session and 
who must ever cherish the highest respect for your professional skill. 

May I still farther trespass upon your patience and ask your advice 
about my sister, who was taken with a convulsion, sometime since, after 
sitting up with St watching him with assiduous attention, during one of 
his attacks. May it not be entirely the influence of the imagination, acting 
on a nervous system, wrought up to the highest degree of sensibility? Please 
write to me, as soon as your professional engagements will permit, and 
give me a detailed treatment of the cases. Please specify the proper dietetic 
treatment also — I mean the articles of diet proper for them. They are 
generally comprehended under the term "light," which is rather indefinite, 
for instance, some physicians prohibit coffee, others recommend it; some 
forbid the lighter meats altogether, others advise them. 

I fear I have already wearied your patience too far and must close by 
tendering you my warmest wishes for your health and happiness. 

I remain your obedient servant, 
William B. Pleasants 

P.S. He has had 4 successive attacks and 11 convulsions in all. Please let 
me know what prospect there is for the successful treatment & permanent 
cure. 

Letter 2. E. B. Pell to Samuel Jackson, Poughkeepsie, N.Y., 25 October 
1839. 

Sir: 

Your letter of the 17th reached me on the 21st instant, since which I 
have applied the remedies recommended by you to my daughter, giving foot 
baths, rubbing the spine and extremities as directed, with every attention to 
diet, etc., suggested by you — except that her hair has not yet been cut off, 
which I thought you might deem unnecessary when informed that she has 
been unusually free from headache, and that her attacks have not been 
preceded by any pain or uneasiness in the head, and though she has com- 
plained of headache after her most violent attacks, they have never been 
severe nor of long duration. It may, however, be well to state that since 
Tuesday 22nd, when I commenced pouring cold water over her head, she 



Letters on Epilepsy 



87 



has complained of a dull, heavy headache and this morning has suffered 
much with a bad sick headache, and throbbing in the temples, a thing I 
never remember her being affected with before. Finding her head so uneasy 
in consequence, I have only poured water over it once a day and wait your 
further directions, whether you still consider it necessary she should lose 
her hair, and that I should persevere in bathing her head. 

I will now answer your questions respecting her general health. Her 
bowels are most commonly in a healthy state; but she is sometimes a little 
troubled with costiveness and flatulency, which have been relieved by a 
mild aperient pill. Any irregularity of the bowels has an immediate and 
decided effect on the state of her nerves. Her monthly courses have never 
been either interrupted or deficient or attended with pain. Neither has she 
suffered any uneasiness of the spine, though I have examined it several 
times under direction of a physician with the view to detecting disease 
there. The spasmodic action of the muscles with which she is affected daily, 
more or less, are not accompanied by any sensation beyond a momentary 
absence of mind; and her convulsive attacks are preceded by no pain or 
uneasiness of any kind, except at the moment she goes off, when she 
afterwards describes having felt what she calls an awful feeling, a giddy 
whirl in her head, and a sense as of falling backwards. 

In your list of articles to compose her diet, you do not mention any 
kind of fruit. Please to say whether you object to her taking baked apples, 
stewed pear, or other simple preparations of fruit. 

I remain, Sir, yours respectfully, 
E. B. Pell 

Letter 3. Richard D. Arnold 4 to Samuel Jackson, Savannah, Ga., 23 July 
1841. 

Dear Sir: 

Miss Madeline Williamson, being about to visit the North, I have 
thought it most prudent to furnish her with a letter to you, in case she 
should have any return of the affection for which she has been under my 
care. On the 30th of March last, she was seized with very violent epileptic 
convulsions. I ascertained afterwards that precisely four weeks anteriorly, 
she had been attacked in Charleston when on a visit. As the physician there 
had treated her entirely with spirits of hartshorn, I supposed her attack to 
have been hysterical, & although under my care before the 30th of March, 
it was not until I witnessed her convulsions that my eyes were opened to 
the real nature of the disease. I should state that the physician in Charleston 
had seen her in one of her attacks. 



4. Richard Dennis Arnold (1808-1876), M.D. University of Pennsylvania, 
1830, Savannah, Georgia, practitioner and educator. 



88 



Jack Eckert 



Happening to be in the house at the time of her attack, I saw the whole 
spasm from beginning to end. I bled her from the arm copiously. The 
next morning, I called in Dr. Waring, 5 who had formerly been the family 
physician before his health interfered with his practice. Just at the time of 
his visit, a severe convulsion came on. She was again bled to about 20 
ounces. After tying up the arm, another convulsion came on but not so 
violently as the others. Calomel 10 grains & two hours after castor oil 
were then ordered. Owing to the oil's operating badly, we substituted salts 
senna & manna which we afterwards found to produce very copious 
evacuations. Purging & low diet were continued until all fever had subsided. 

Dr. Waring ordered a close surveillance to be kept upon her & I visited 
her daily. We ascertained that her menstruation was very scanty. On the 
11th of April, she complained so much of her head that I bled her. She had 
a great deal of dull, heavy feeling in her head, for which I several times 
prescribed salts senna & manna. Her attacks commenced always by an 
aura beginning at the top of the little finger & running up the arm when 
it terminated in a violent convulsion. 

On 23rd April, at 7 p.m., she was attacked by the aura, but no convul- 
sion ensued. The general circulation was much disturbed, the pulse being 
full & frequent. I had wished to try a system of gradual & continued 
leeching behind the ears & over the spine, but she had obstinately refused 
to submit to that treatment. Being alarmed, she now consented, & I applied 
leeches over the course of the nerve in the little finger & over each mastoid 
process, while I bled her copiously from the arm & exhibited calomel 10 
grains to be followed the next morning by salts senna & manna. 

In the afternoon of the next day, Dr. Waring again met me in consulta- 
tion. Her pulse having begun to rise & her head to ache, we again bled 
her, &C if it at my night visit there was any excitement of the pulse, I was 
to bleed again, which I did. We continued to purge her & keep her on gruel 
until all general excitement had disappeared. On the 27 April, Dr. Waring 
ceased visiting her. 

To keep her bowels open after her recovery, I prescribed pills of aloes, 
rhubarb, & soap. Her diet was nutritious but plain. 

Since that time, she has had no attack of either the aura or convulsions. 
In the beginning of June, I put her upon the use of the hydriodated tincture 
of iron. This acted as a tonic & completely restored the menstrual function. 
She has greatly improved in her general health & is now much stouter & 
fatter than before her attack. 

It has been an extremely interesting case & considering the violence 
of the convulsions, has, so far, eventuated much more favorably than I 
dared to anticipate at first. Not a single antispasmodic was resorted to. The 
treatment was purely antiphlogistic. 

5. Probably Georgia practitioner William Richard Waring (d. 1843), M.D. 
University of Pennsylvania, 1813. 



Letters on Epilepsy 



89 



Very respectfully your obedient servant, 
Richard D. Arnold 
(of the Class of 1830) 

Letter 4. William B. Cochran 6 to Samuel Jackson, Middleburg, Va., 
1 November 1844. 

Dear Sir: 

A patient, & friend of mine, Mr. McCarty, about thirty-four years of 
age, was taken on the 31st of August last with a convulsion resembling 
epilepsy. I was summoned in great haste, but when I arrived, the attack 
had passed off. It was the first time in his life he had ever had such an 
attack, but since then he has had four or five. They come on with a peculiar 
stinging sensation in the thumb & two forefingers of the left hand, gradu- 
ally extending up the arm, to the muscles of the face & of the left side 
which are much drawn & convulsed. The left eye also rolls incessantly. He 
then becomes insensible for a minute or less, & the attack passes off. There 
is nothing of that foaming at the mouth or disposition to bite the tongue 
that the epileptic usually have. About three weeks previous to the first 
attack, he was suddenly taken with a numbness in the thumb & forefinger 
of the left hand, which has never left him. 

His habits have been strictly temperate; he never touches alcohol in 
any shape. He has led a farmer's life in every respect & used a farmer's 
diet. He drank a good deal of coffee & used tobacco [freely?], to which two 
articles I attributed the symptoms of indigestion, of which he occasionally 
complained to me. He had also complained to me of palpitation of the 
heart, which I considered symptomatic of the disordered stomach. 

He is frequently threatened with these attacks, that is, this peculiar 
tingling in his fingers comes on, & he thinks he had checked them by 
bathing his hand in spirit as hot as he can bear it & drinking at the same 
time some raw brandy. I have chiefly pursued the treatment directed by 
you in a lecture published in the Medical Examiner. I have given occasion- 
ally emetics, persisted regularly in the tonic pills, dieted him strictly, & 
have now a seton 7 in the back of his neck. I wish you to inform me what 
course you think ought to be pursued, & if any other, what treatment? 
Your early attention to this subject will greatly oblige, very respectfully, 
your friend, 

William B. Cochran 



6. William Bailey Cochran (d. 1898), M.D. University of Pennsylvania, 1831, 
Middleburg, Virginia, practitioner. 

7. A seton is a strip of linen, cotton, or silk, passed through the skin to promote 
or maintain a discharge. 



90 



Jack Eckert 



Letter 5. G. W. Mc. Semple to Samuel Jackson, Charles City Court 
House, Va, 15 April 1845. 

Dear Sir: 

I have a case under treatment which has perplexed me much and about 
which I am anxious to have your advice. 

The son of Hill Carter of Shirly, in his infancy & childhood, was 
subject to frequent attacks of what his physician said was croup, for which 
he was frequently, up to the age of 9 years, in the course of every winter, 
treated by most copious bleedings & very large doses of calomel. In the 
course of 24 or 48 hours, he would often lose 20 ounces or 30 ounces of 
blood and take 1 drachm or 2 drachms of calomel. 

I was sent for to see him during the last summer, late in August. 
He was then 10 years old, well-grown, light hair, black eyes, fair, florid 
complexion, full chest, sprightly, intelligent mind. During the past winter, 
he had had no attack of croup 8t was apparently in fine health. His pulse 
was regular & his secretions good. His bowels regularly open twice daily 
&C his appetite and digestion good. His parents informed me that all they 
saw amiss in their boy was a frequent loss of consciousness for a few 
moments at a time. His countenance would assume a fixed, vacant expres- 
sion. If he were in motion, he would stop and remain fixed. If reading, he 
would stop and, after a long, deep-drawn sigh, go on from the place he 
had left. He was fond of rowing a little boat on the river with his brother 
&C would often lose several strokes of his oar. He was entirely unconscious 
of anything unusual. 

I advised he should be restricted in his diet to bread and milk for 
breakfast & early supper, that he should be allowed the more digestible 
fresh meats at dinner with wholesome vegetables, & that the quantity of 
food should never be sufficient to satisfy his appetite. He was thus some- 
what reduced by the middle of September. He was then ordered to have a 
blister kept constantly open behind each ear. The paroxysms were thus 
reduced about one-half in frequency. 

By the 20th December, I was enabled to procure a constant supply of 
leeches, which would at first have been preferred to the blisters, & one was 
ordered every third night, behind each ear. His mother thinks that his 
paroxysms were for a time reduced somewhat in frequency by their use, & 
he has lost more flesh. 

In other respects, he continues much as when I first saw him. It was 
my intention to have resorted to some antispasmodic & tonic medicine, 
but will delay any change of treatment until I hear from you, my much 
respected preceptor. It is not intended to impose this trouble on you without 
compensation, though I am sure the interest which you take in an old 



8. George William McKenzie Semple (1812-1883), M.D. University of Pennsyl- 
vania, 1834. Semple was a surgeon in the Confederate Army during the Civil War. 



Letters on Epilepsy 



91 



student would procure as much from your liberality for one who has seldom 
troubled you. Be good enough to make out your account and forward it 
to me enclosed in your reply, & Mr. C. will remit you the amount through 
my hands when he settles my account. 

Be assured of the continued respect & gratitude of your former student, 
G. W. Mc. Semple 

Letter 6. John Thomas Pritner 9 to Samuel Jackson, Clarion, Pa., 29 
December 1846. 

Dear Sir: 

During my attendance at the Medical University of which you are 
a professor, accident placed me in your rooms a few times. From this 
acquaintance, I presume to ask your opinion in the following case. 

A single female, age 24, called in January 1846. Complained at inter- 
vals of pain in the back part of the head, rather around the center or 
crown of the scalp. Also she had what she called "weak spells." She would 
suddenly sink down, be insensible to external impressions, the breathing 
and circulation continuing, though both rather slower than natural. These 
occurred twice and three times a week, duration from fifteen to twenty 
minutes. From inquiry, I found her menses regular though sparing, also 
leucorrhea and costiveness. I put her under treatment for the leucorrhea, 
etc., and in March following, she was relieved of the fluor and the menses 
more abundant. General health improved though still complained of pain 
in the head. I directed the cuticle application of morphine, cold bath, and 
muriated ti[ncture of?] iron with infusum quassiae. At this time she left 
town and returned home, 20 miles distant; heard nothing more of her until 
June. Summoned in haste to see her. She had the day previous suddenly fell 
down insensible, remained so for about an hour, when she took spasms or 
cramps. The muscles in the front part of the body would gradually contract 
until she would be drawn together as much as possible. This continued a 
few minutes, and she would relax, though lay insensible. In half an hour 
(perhaps sooner), another set of muscles, those of the back or right side or 
left, would contract, and so on. These attacks would last five or six hours 
before she would become sensible. In the interval, she would converse 
rationally, eat a little. Arterial circulation below the natural standard. Bow- 
els in a natural state. Ether ammoniae, musk, and some other restoratives 
were resorted to with stimulating functions to the surface without any good 
effect, but continued for four days, increasing in severity. 

I administered the quinine in twelve grain doses, an hour and a half 
apart. After the third dose, the peculiar effects of the medicine appeared. 



9. Probably Thomas Pritner, M.D. University of Pennsylvania, 1829, Clarion, 
Pennsylvania, practitioner. 



92 



Jack Eckert 



It was discontinued, and that night the spasms were not so severe. For five 
successive mornings, the quinine was given in the doses above, and spasms 
ceased. Quinine was continued in smaller doses for two weeks. She gradu- 
ally improved, menses regular, no fluor albus. The pain in the head contin- 
ues, and she thinks that the seat of the disease. I have used in succession 
blistering, croton oil, tartar plasters, and she is now wearing a seton in the 
back of the neck. I also tried strychnia for five or six weeks, all without 
any sensible effect. 

Three weeks ago, she fell down insensible and lay in this state for five 
days (no spasms), took no nourishment during this time, swallowed a little 
water with much difficulty. I directed a cold bath, and she was suddenly 
restored to consciousness. She is very weak, though now gradually improv- 
ing. She is taking the quinine, using the cold bath. Senna occasionally to 
open the bowels, but the digestive organs are good in the main. 

I believe it to be a disease of the nerves, call it neuralgia, &C several 
other gentlemen have given it the same title. But this is not relieving the 
patient. The subject of this has an unblemished character, is intelligent, and 
has received a liberal education. Now if you will give me your opinion and 
suggest some treatment in the case, you will ever command in my regard 
& esteem. 

John Thomas Pritner 

Letter 7. W. C. Haymond to Samuel Jackson, Fairmount, Va., 12 Sep- 
tember 1848. 

Sir: 

I am 45 years old, enjoyed better health than is usual [until] February 
1847, when I was attacked with epilepsy while arguing [with] a cousin in 
court — a disease which I had then thought but little about, and my 
attention was not directed to it until 5 months after, at Saratoga Springs, 
at which time and place I had a second paroxysm, in the course of four 
weeks, a third, and then in about eight weeks, two, and about the same 
time, three in half-hour intervals, then seven twice, until after those 7 the 
second time, they was all called severe. They have since become lighter and, 
recently, of shorter intervals, and generally but one now at a time, after 
which I have some pain in the head, vomit, and feel restless for a few hours, 
after which I can get up and go about as usual. I have always had the 
paroxysms to continue until this disturbance of the head & stomach, which 
has induced me to believe it there that the disease is located. 

I have slight pains occasionally in my legs, feet, shoulders, etc., fre- 
quently look sallow complected and ghostly a few days preceding an attack, 
but usually well at the time. My nose has ached for many years every few 
days to such a degree that I would have to rub it with all my strength for 
a few minutes for the last three months. The membrane which lines the 



Letters on Epilepsy 



93 



inside of that member has been inflamed and ulcerating in its appearance 
and so continues. My lips also frequently ache of late. My neck is frequently 
slightly affected something like what is called a crick in the neck. I have 
had the piles for many years. They are not any worse than I know of those 
formerly. I sometimes have some pain in the small of my back before 
attacks. 

I am stout, 6 feet high, and usual weight 155 since grown, and that is 
now my weight. Have been fond of strong diet and used tobacco to a great 
excess for 25 years; quit entirely about 14 months since. Have used spirits 
moderately. Took nitrate of silver for 4 months for this disease and have 
used a cold shower bath for 12 months and now using it and taking Jones's 
Sedative Pills every day to keep my bowels open. I have all my life been 
inclined to be costive. 

I have been advised to call upon you for your advice and treatment 
should you think my case one that could be likely reached by medicine or 
other treatment. I have given you the outlines of the case and would desire 
to know whether you think you can cure me or not and if it would be of 
any advantage for me to visit Philadelphia. If so, I will come on there in 
the month of October. I have no idea of what your fee for advice will be, 
but will send it to you when I hear from you or should you desire me to 
be there in person, I will bring you the fee. Please inform me in either case 
what it will be. 

Yours respectfully, 
W. C. Haymond 

Letter 8. W. C. Haymond to Samuel Jackson, Fairmount, Va., 3 Novem- 
ber 1848. 

Dear Sir: 

On the day before I arrived at home, I had a return of my paroxysms, 
and four days afterwards, I was again attacked, at which time I had two 
at intervals of five hours, which is very near if not precisely like I was 
attacked before I started and while on my way to Philadelphia. My health 
otherwise is about as it has been. You will recollect that I mentioned to 
you that I had been troubled for 20 years with an aching of the nose and 
that I had latterly felt some little aching and singular feeling in my upper 
lip. On one occasion, a few days since, that feeling and aching of the lip 
developed itself more fully by my said lip swelling in a few minutes to 
double its usual size, which swelling in the course of five hours entirely 
abated, and things appeared as before. I know that the swelling was not 
from any local cause. If not, can you account for it without worms? I 
should be glad to know. 

I still continue the powders and diet as you directed. Can I with safety 
add beef soup and butter or either of those articles to my diet? 



94 



Jack Eckert 



I hope you will inform me soon in relation to the above. I am not 
disposed to be troublesome and am willing to compensate you at any time 
for your services. 

Am respectfully your obedient servant, 
W. C. Haymond 

Letter 9. Francis H. Deane 10 to Samuel Jackson, Richmond, Va., 4 De- 
cember 1848. 

Dear Sir: 

Although a stranger, I take the liberty of addressing you a few lines, 
feeling you will readily excuse me. 

I have under my care an interesting young woman who is desirous to 
have your opinion concerning her case. An uncle of hers & perhaps other 
relatives who were under your care some years ago & who thought they 
were greatly benefitted makes her peculiarly solicitous to have your advice. 

Her age is seventeen, menstrual flux commenced when she was only 
twelve, has occurred regularly ever since. Bowels rather inclined to consti- 
pation. General appearance of the patient indicates perfect health, spirits 
always good, mind unimpaired. At the age of fourteen, was seized with 
spasms. These have continued almost uninterruptedly ever since. Periodic- 
ity does not exist; sometimes they will occur every 2 or 3 days or weeks. 
Until within the last 1 1 months, the interval between them was never longer 
than 2 or 3 weeks. Within the last 1 1 months, she had an exemption for 
nine months. This occurred whilst she was under no particular treatment. 
The only circumstance worth mentioning is the fact that about twelve 
months ago, she was residing in Mississippi St since has resided in this city. 
This exemption had existed for six or eight weeks before she left Missis- 
sippi, so I am unable to say what result to ascribe to change of climate. 

She has used setons, taken zinc, iron, etc., etc. Since she has been under 
my care, I have not directed any specific treatment, merely used remedies 
calculated to promote her general health. The nitrate silver had never been 
tried. The health of the patient is so good I have thought possibly marriage 
might relieve her symptoms. To this she objects from motions which will 
readily suggest themselves. She desires me to say that if you feel you could 
relieve her, she would take up her abode in your city, although it would be 
accompanied by expenditures she could not very well afford. 

I hope, sir, you are well & in the enjoyment of a large portion of this 
earth's happiness. Whilst I never had the pleasure of any other acquaintance 
than the casual one that sometimes takes place between professor & stu- 



10. Francis H. Deane (d. 1870), M.D. University of Pennsylvania, 1832, Rich- 
mond, Virginia, practitioner. 



Letters on Epilepsy 



95 



dent, yet I have for you a feeling that I can call by no other name than the 
sacred one of friendship. 

Respectfully &£ truly, 
Francis H. Deane 

Letter 10. W. C. Haymond to Samuel Jackson, Fairmount, Va., 1 Febru- 
ary 1849. 

Dear Sir: 

I wrote to you some time since, informing you that I had stood up 
under one of my attacks and retained my reason. Have not heard from you 
since. 

Since that time, I have had two very light ones in which I lost my 
reason, & one of them was night before last, and on yesterday, I had three, 
and today, two of those attacks without losing my reason, and keeping my 
feet all the while. I do not understand this aspect of the disease and thought 
it prudent to apprise you of this change. 

Upon yesterday, when I had those attacks, I did not jerk very much, 
felt cold as they went off, and afterwards my pulse was regular, when they 
were on, say at about 70, little slower and softer after they were off. My 
heart fluttered considerable while those spells were on. Those spells are in 
all respects like those with which I was originally attacked, except that I 
am able to stand up and retain my reason, which, by the by, is considerable. 
I have thought it advisable to inform you of this change the disease was 
about making apparently. Have you ever had a case like this before, as it 
seems to me now that the treatment might now require a change? I shall 
be glad to hear from you. 

Yours respectfully, 
W. C. Haymond 

Letter 11. A. F. Gregory to Samuel Jackson, Austinville, Va., 4 February 
1849. 

Dear Sir: 

This is to inform you that since I adopted your prescription given to 
me last fall, my general health has been much better than it had been for 
the year previous. Notwithstanding, I have had three paroxysms since the 
1st October last, neither of which have been as severe as usual. The last I 
had was on last night about 8 o'clock which lasted but a few minutes. I 
had been in dread of this attack from Tuesday the 30th ultimo, as from 
that day I had been a good deal afflicted with colic. My diet since I had 
the pleasure of seeing you has been macaroni, mush, rice, bread, and milk, 



96 



Jack Eckert 



and I have taken two of the powders daily which you directed me to take. 
Since I have been taking the powders, I am subject to colic, to which I was 
not before, whether it is owing to the effect of the powders or not I 
cannot say. Doctor Sanders, one of the physicians of the neighborhood who 
prepared some of the powders, says not. In consequence of the coldness of 
the winter here, I have not taken the shower bath. Another reason is that 
I have been much affected with a cold this winter but had no cough. The 
attack which I had last evening may have been produced from eating a 
small piece of fresh venison, which was very tender, for dinner, or taking 
some tea for supper with a view of it stimulating me and relieving me of 
the pain in the bowels and stomach, instead of milk which is my usual 
beverage. 

I am not near so much affected with giddiness of the head as I was 
before I commenced using your prescription, nor am I so much affected 
with the glimmering before my eyes. When affected with colic, I am afraid 
to take any stimulant, fearing it may affect my head. 

You will much oblige me be instructing me whether I am to continue 
the use of the powders as usual when I have the colic or not. I will call to 
see you again next spring, if you consider it necessary, but if not, I had 
rather avoid the fatigue of the journey to your city. 

Any suggestions in relation to my future course will be thankfully 
received by your 

Obedient servant, 
A. F. Gregory 

Letter 12. W. C. Haymond to Samuel Jackson, Fairmount, Va., 19 Febru- 
ary 1849. 

Dear Sir: 

I had expected to have heard from you before this. My two last letters 
informing you of a very considerable change apparently in the character 
of my disease has been entirely unanswered. Since I wrote to you last, say 
in about ten days after, I had two slight symptoms of an attack that caused 
me involuntarily to rise to my feet. A drink of water and walk across my 
room would entirely restore me. I then had one that caused me to sink to 
the floor under a violent shaking, like an ague, no jerking. I was conscious 
after I was on the floor, and it is a matter of doubt amongst who were 
present whether I lost my consciousness or not. I was only down about a 
minute. The same night I felt another very slight symptom which passed 
off without my getting entirely up, and about ten days since, I had another 
slight symptom or attack which is the last one I have had. That was so 
slight that a gentleman who was conversing with me did not discover it. 
My heart flutters very much at those times and pulse is tolerably good yet 



Letters on Epilepsy 



97 



a little weak and fast in a short time after they pass off. My heart flutters 
a little at other times occasionally and seems to labor. I have an increase 
of urine a great proportion of the time, but little colored, occasionally a 
small quantity highly-colored. My appetite has been and is good. 

I have not had any pain in the head or sickness at the stomach since I 
wrote to you. You will recollect I told you that my spells was always 
followed by sickness of the stomach and violent headache. This has hap- 
pened but once since I left Philadelphia. I should like to have your opinion 
of my case under this view of it and would like to know whether you 
consider my stomach diseased or not. You need not refrain answering for 
fear of changing my habits in relation to diet. I shall not do so. 

Yours respectfully, 
W. C. Haymond 

Letter 13. Edmund P. Taliaferro 11 to Samuel Jackson, Orange, Va., 30 
December 1849. 

My dear sir: 

Permit a disciple of yours, who attended a summer course of lectures 
in '33 and graduated the following winter, to express his gratitude for the 
information obtained at your hands and now, in the time of need, to call 
upon you again, believing you will do all in your power to relieve suffering 
humanity. 

I married in '37 and have seven children. My lady was healthy, but of 
a nervous temperament. In the fall of 1846, while she was in the family 
way, she had an attack, as I thought, from what I could learn, of hysteria, 
for I was not at home. That was followed by a severe attack of typhoid 
fever, which was prevailing with us at that time. 

In the fall of 1848, she was far advanced in pregnancy, and her mind 
was greatly disturbed, in consequence of a difficulty which her brother had 
with his neighbor. The result was she was jumping and catching frequently 
in her sleep and complained of her head frequently. At length, she was 
taken suddenly with a convulsion and fell on the floor, deprived of sense 
and consciousness. It was soon over, and she did not have another until 
sometime after her confinement. She has had them irregularly since, some- 
times once a fortnight, then again a month. She was confined about three 
months since. After that, she had no attack for three months and four days. 
Several times she has had a second paroxysm a few hours after the first. 



11. Edmund P. Taliaferro, M.D. University of Pennsylvania, 1834, Virginia 
practitioner. 



98 



Jack Eckert 



She has been taken generally in the night, but several times in the day. After 
the paroxysm, she is dejected and low-spirited for several days, disposed 
to weep. 

I have never seen a case of epilepsy before, though I believe her case 
comes under that head. I have been called to Mr. Quintus Barbour, 12 who 
you have been attending, but never saw him in a paroxysm. 

I was in hopes my lady's was more hysterical, as they occurred during 
pregnancy, and she was naturally more nervous, though remarkably healthy 
and possessed a fine flow of spirits. She compares her feeling, just before 
an attack, to water rushing over a dam and sometimes complains of ringing 
in her ears. At first, she was satisfied her memory suffered, but, of late, I 
have not discovered it. She has a remarkably fine memory, never forgets 
dates, etc. 

The paroxysm lasts a few minutes. Her face is generally drawn (I 
should have said, always to the right) and her tongue suffers if not protected 
by putting something between her teeth. She sleeps then for several hours, 
then rises and complains of weakness, but goes about her ordinary occupa- 
tion, for she is naturally inclined to be industrious. She complains of sick- 
ness of stomach after each attack and, frequently, of pain in her womb 
and, lately, of difficulty in retaining her water. 

She has been always so healthy that I have been unable to restrict her 
to a regular diet. I have tried counter-irritation to the nape of neck (tartar 
ointment) and cupping the temples and tinctura digitalis, valerian, etc., to 
quiet nervous irritation and mild cathartics for the bowels — without any 
apparent effect. 

It rests with you, my dear sir, with your extensive experience, to lay 
down some plan or suggest what you think most advisable under the 
circumstances. I have not tried nitrate of silver; what is your experience 
with it? 

I liked to have forgotten to add, her attacks occur oftener at the full 
and change of the moon, than otherwise. 

I believe I have given you an accurate description of her case; I must 
conclude, hoping and believing I shall hear from you soon and that you 
will do all in your power to relieve the affliction of one that is near and 
dear to me. 

Very respectfully your friend, 
Edmund P. Taliaferro 

She is tall, neck longer than usual, and weighs about one hundred & 
twenty. 



12. A letter from Quintus Barbour to Samuel Jackson is included in the 
collection. 



Letters on Epilepsy 



99 



Letter 14. John Seibert 13 to Samuel Jackson, Johnsville, Ohio, 6 January 
1851. 

Dear Doctor: 

Having lately had a number of cases of epilepsy in children to treat, 
and being disappointed in the various remedies usually laid down in books 
for this complaint, such as camphor and opium, nitrate of silver, etc., I 
should, however, state that while I resided in Maryland, I administered the 
extract of stramonium, with effect, in epilepsy, but the symptoms resulting 
from its use were of such a terrible character that I have since abandoned 
its use in this disease, and I thought that from your extensive book and 
practical knowledge, you might possible suggest a more effectual remedy. 

Any information communicated will be kindly and thankfully received 
by your old pupil and admirer. 

John Seibert 

Letter 15. Virginius W. Harrison 14 to Samuel Jackson, City Point, Va., 
2 July 1854. 

My dear sir: 

It becomes my duty to consult you in reference to a case of disease in 
the person of a sister of mine, aged 13 years. For two years or more, a 
disease seems to have been working insidiously upon her system, which at 
first was very lightly regarded, but at present, with apprehensions of an 
unfavorable issue. The disease, we fear, is epilepsy. Two years ago, she was 
observed to stop suddenly, when actively engaged at play, with a vacant 
stare and seemed perfectly unconscious of and indifferent to all passing 
around her. She would appear perfectly calm, features in no way distorted, 
though perfectly destitute of consciousness. This state would last not more 
than a minute, when she would continue in her amusement as if nothing 
had happened. This would occur very seldom at first, but more frequently 
at present, several times during the day. Should she become confused in her 
ideas — suddenly alarmed or excited — this state of mind is very apt to 
make its appearance. 

About 3 months since, she had purpura, which soon yielded to treat- 
ment. At this time, she is rather anemic. A few days since, she had a decided 
convulsion before recovering from sleep, early in the morning, at least no 
one was cognizant of her having been aroused from her slumber previous 
to its occurrence. It lasted about fifteen minutes. She complains of pain 



13. John Seibert (d. 1896), M.D. University of Pennsylvania, 1845, Chicago, 
Illinois, practitioner. 

14. Virginius Williams Harrison (1829-1879), M.D. University of Pennsyl- 
vania, 1851. Harrison was a Confederate Army surgeon during the Civil War. 



100 



Jack Eckert 



in the epigastrium frequently attended with nausea, though seldom with 
vomiting, occasionally with fullness about her head. She is quite anemic, 
though she has taken the preparations of iron for some time. She was 
cupped soon after the convulsion passed off. She is still taking iron and 
uses the cold bath and wet bandage around her body daily. She is naturally 
of a lively disposition, sprightly mind, and very fond of study. The day 
before she had the convulsion, she had eaten a portion of cucumbers for 
dinner. 

I would be very grateful, my dear sir, if you would write me your 
views about the case, as regards its nature and treatment. Perhaps you may 
have forgotten me. I was a pupil of yours in 1850-1851 and a graduate 
of the University of Pennsylvania. 

Hoping this may find you well, I remain, 

Yours very truly, 
Virginius W. Harrison 

Historical Collections 
College of Physicians of Philadelphia 
19 South 22nd Street 
Philadelphia, PA 19103 



Report of the President of the College 
of Physicians of Philadelphia at the 
Annual Meeting of the Fellowship, 
26 November 1991 

DANIEL L. SHAW, JR. 

Fellows of the College of Physicians of Philadelphia, it is a privilege 
to share with you the Report of the President for 1991. It has been 
a year of substantial accomplishment for the College, building on 
past achievements and made possible by hundreds of loyal and 
generous supporters who value, as I do, the contributions of the 
College to medicine and to the community. 

The theme of my report to you a year ago focused on what I 
called "infrastructure." Broadly speaking, we have concentrated our 
efforts over the five years that began this institution's third century 
with securing our foundations. By restructuring the way we govern 
and manage this institution, improving our operational and fiscal 
controls, and establishing programs for fund development and 
member relations, we have significantly strengthened the College's 
ability to recoil undamaged from pressure or shock. That is, we 
have in good measure institutionalized resilience. Thus encouraged 
and fortified, the College begins the next five years in an effort to 
enhance its relevance. The College's programs must be made more 
relevant to its Fellowship, the medical and health care communities, 
and the public. In the report that follows, I should like to describe 
the progress of these pursuits and briefly to point to plans which 
will be improved by your advice and ultimately fulfilled with your 
continuing support. 

Allow me now to report to you on the accomplishments of 
the past year with respect to operations. Last year the College's 
governance completed its first year under its new system of quarterly 
meetings of the Council, monthly meetings of the Executive Com- 
mittee, and regular meetings of five standing committees. I am 
gratified to report that this arrangement has improved the coordina- 
tion of business, intercommunication among our volunteer leader- 
ship and between governance and management, and oversight of 
the College's operations. This year, according to schedule, we have 



101 



Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 101-106 
© 1992 by The College of Physicians of Philadelphia. 



102 



Report of the President 



begun the process of creating special committees to carry out institu- 
tional objectives by means of voluntary efforts of our Fellows. 
Under the guidance of the Committee on Development, chaired by 
Dr. Frederick Murtagh, a group of volunteers has been assigned to 
help fulfill the goals of the College's new planned giving program. 
Under the auspices of the Committee on Fellowship, chaired by Dr. 
Edward J. Resnick, a new Fellowship Enhancement Committee has 
been created to identify and help recruit the most promising candi- 
dates for College Fellowship and to assist the College's leadership 
in determining ways of enriching the Fellowship experience. This 
network of workers will be led by Dr. Wallace G. McCune. 

Fund development and Fellowship enhancement are keys to 
institutional stability. I am pleased to report that in Fiscal Year 1991 
the College inducted 179 new Fellows. Currently 2,067 members 
strong, the Fellowship of the College stands at an all-time high, 
though still fewer than our mandated ceiling of 2,500 members. 
Also in Fiscal Year 1991 the College received over $524,062 in new 
gifts and pledges. This includes a record $150,474 in annual gifts 
from 625 donors. It does not count another $394,649 received 
during the year as payments on pledges to the successful New Cen- 
tury Fund campaign. The new planned giving program, alluded to 
earlier, represents an effort not only to secure the future of the 
institution by enhancing its endowment and strengthening its pro- 
grams but also to provide the Fellows with immediate, tax-wise 
vehicles for improving their own investment and estate planning. 
For this mutually beneficial program, we have retained the services 
of a consultant to complement the College's volunteer and profes- 
sional energy and expertise. Already several gifts have been and 
are being structured that will repay many times over the College's 
investment in this program. We continue to receive gifts to endow 
subscriptions to journals in our Library under the auspices of the 
S. Weir Mitchell Program and we encourage additional commit- 
ments to the program in order to meet the Library's needs. A new 
and needed initiative to organize a group of friends of the Library's 
Historical Collections, each of whom pledges $1,000 annually for 
the purchase of special materials, has had an auspicious beginning. 
The Samuel Lewis Circle already has 14 members. 

Internally — operationally — the College continues to manage 
its affairs with diligence. Thanks to our increased capacity to en- 
hance revenue, control costs, increase efficiency, and maximize pro- 
ductivity, the College's financial performance surpassed its budgeted 



Report of the President 



103 



projection by $35,61 1 last year. This achievement continues a favor- 
able four-year trend. This year, for the first time in recent memory, 
we project a balanced budget. 

Currently, the College is in the midst of two exercises which 
typify and, in a way, culminate the five-year effort to rationalize 
the way the institution operates. First, a state-of-the-art computer 
system is being installed and programmed to drive our operations 
efficiently and effectively. Second, we are constructing the first busi- 
ness plan in the College's history. Called the Three-Year Plan, it will 
attempt to predict and define with as much precision as possible the 
activities of the College of Physicians of Philadelphia over a period 
beginning 1 July 1992 and ending 30 June 1995. It will serve as a 
management and assessment tool to help us achieve utilization and 
proper allocation of our resources in fulfillment of the College's 
institutional mission. 

What is most gratifying to me in reviewing such progress is the 
way in which governance, management, and dedicated volunteers 
have conspired to achieve results. In the area of institutional en- 
hancement, the committees of Development and of Fellowship 
work closely with the Office of Institutional Advancement, headed 
by A. Jerry Condon. In the area of institutional operations, the 
committees of Administration and of Finance cooperate effectively 
with the newly reorganized Office of Finance & Accounting, admin- 
istered by Benjamin Pierce. Chaired by Dr. William C. Frayer, the 
Committee on Administration last year provided critical oversight 
and valued advice as the College constructed a new employee bene- 
fits package and a new personnel policies manual and employee 
handbook. The way we select, train, manage, compensate, and 
reward our employees is directly related to the productivity, stabil- 
ity, and success of our organization. I am proud to say that the new 
package offers the staff more benefits, but at less cost to the College, 
than the former plans. Our ability to create our employee handbook 
in-house saved tens of thousands of dollars. This year the Commit- 
tee on Administration is concentrating on the establishment of a 
long-sought capital needs assessment plan and program. 

The Committee on Finance, chaired by Dr. Charles T. Lee, 
Jr., has provided excellent oversight of the reorganized financial 
operations of the College. Working with the Investment Committee, 
it has refined our investment policy. It has devised a spending rule 
that allows the College to respond flexibly to long- and short-term 
needs. Its leadership role in establishing a balanced budget reflects 



104 



Report of the President 



the effective collaboration and cooperation of governance and 
management. 

Assisting both management and governance is the College's 
Board of Advisors, chaired by John W. Eckman, L.H.D. I cite with 
particular thanks the efforts this past year of two key advisors: 
Philip A. Metcalf and Philip W. Young. Respectively, they provided 
invaluable advice to the College in the critical areas of computer 
reconfiguration and investment performance analysis. Finally, I 
must acknowledge the individual who orchestrates this complex 
symphony, our executive director John M. O'Donnell, whose com- 
mitment, enthusiasm, and leadership have made a difference. 

It is safe to say that our sails are trimmed and it is important 
now to concentrate on where we are bound and with what cargo. 
Dr. Robert H. Bradley, Jr., chairs the Committee on Program, which 
is largely responsible for navigation. Its function, as I shall quote 
from the By-Laws, is large: "The Committee on Program shall 
oversee and evaluate the functioning of all aspects of the College's 
relations with the Fellowship, clients, and other constituencies in 
the medical community and the larger public as transacted through 
the College's Library, Mutter Museum, Francis C. Wood Institute, 
Committee on Public Health, and programs of lectures, publica- 
tions, and awards." That is a sizeable responsibility. 

Our Library, co-directed by Andrea Kenyon (Public Services) 
and Thomas Horrocks (Historical Services) remains a powerful 
resource of biomedical information, contemporary and historical, 
for the region and the nation. Locally, our library is the major net 
lender of information. As an Area Resource Library of the National 
Library of Medicine's Regional Medical Library Program, it is the 
region's primary resource. During the first six months of this year, 
to cite one example, the College loaned via this network in excess 
of 22,000 articles, followed by the New York Academy of Medicine 
with 16,000 loans, and the University of Massachusetts with 10,000 
loans. 

As a founding member of the Health Sciences Libraries Consor- 
tium (HSLC), it is helping to build a nationally replicable model for 
the rapid and economical delivery of biomedical information. As a 
participating member of the Philadelphia Area Consortium of Spe- 
cial Collections Libraries (PACSCL), it received last year a three- 
year grant totalling $162,526 from the Pew Charitable Trusts for 
processing and cataloging rare works and manuscripts in the Histor- 
ical Collections of the Library. Last month, the College's Council 



Report of the President 



105 



approved the Collection Development Policies of the Library and 
the Museum, a massive effort to relate the goals of these divisions 
to those of the institution, to provide a rational basis for collection 
decisions, and to indicate to the outside world our strengths and 
direction. 

In May, the Wood Institute sponsored a major conference on 
a contemporary health care issue, that of medical malpractice re- 
form. The conference, "Seeking Common Ground: Law, Medicine, 
and Patient Care in the 1990s," was the culmination of a year-long 
Law and Medicine Project that involved doctors, nurses, insurance 
executives, judges, legislators, and policy scientists. Its success in- 
creased the visibility of the College not only in the health care 
community but also in the legal and legislative arenas. 

Institute director Caroline Hannaway recently received a grant 
of $85,000 from the National Endowment for the Humanities to 
research and hold a conference at the College on the "History of 
Scientific Medicine in Paris, 1790-1850." The conference is planned 
for 21-22 February 1992. 

The excellence of the College's resources is matched by that of 
its staff, as indicated by their professional standing among their 
colleagues. During the past year, Andrea Kenyon served as president 
of the Philadelphia Chapter of the Medical Library Association; 
museum director Gretchen Worden was president of the Museum 
Council of Philadelphia; Thomas Horrocks was a member of 
PACSCL's Executive Committee; Caroline Hannaway chaired and 
served on numerous committees of the National Library of Medi- 
cine and of the American Association for the History of Medicine; 
and John O'Donnell presided over HSLC's Board of Directors. 

In the coming years, as will be evidenced in the College's Three- 
Year Plan, we shall attempt to fulfill two principal goals for our 
programs: first, to put them more rigorously in service to our institu- 
tional mission; second, to create synergy among them. For example, 
one aspect of the College's mission is "to contribute in all appro- 
priate ways to the health of the community." One way of doing this 
is by supporting comprehensive health education in the region and 
specifically within the schools. Under the leadership of Dr. Robert 
G. Sharrar, chairman of our Committee on Public Health and Pre- 
ventive Medicine, the College and the School Board of Philadelphia 
have jointly impaneled a planning committee composed of represen- 
tatives from the College and the School District in an attempt to 



106 



Report of the President 



develop a community coalition in support of the District's health 
education initiatives. 

It is clear that the public perceives the College as a potentially 
strong advocate on health and health policy issues. We are taking 
this role seriously in our planning. In addition to our role as advo- 
cate, we are discovering that we have many resources with which 
to support health education. Our Library's vast resources, particu- 
larly its state-supported Health Information to Pennsylvania Resi- 
dents Program, can be put at the disposal of health educators. 
The Mutter Museum can become a powerful laboratory for health 
education projects. In fact, the Museum has recently submitted a 
grant proposal to the Howard Hughes Medical Institute in the 
amount of $382,776 to expand the Museum's program for schools' 
field trips, to build a program of anatomical study, to provide 
student internships, to collaborate on education and career orienta- 
tion projects with a health science magnet school, and to help teach- 
ers enhance their health and science curricula. The College has 
recently "adopted" a Philadelphia public school and, under the 
auspices of the Committee on Public Health, is laying the ground- 
work for a guest speakers program on such topics as substance 
abuse, disease prevention, nutrition and fitness, and other topics of 
vital concern. A portion of our College lecture program is being 
dedicated to a discussion of health issues facing our community. 

In short, we have begun to realize that, by using our full range 
of institutional resources, we can make an impact. In the coming 
months and years, we shall be setting our direction, outlining our 
plans, and encouraging your recommendations and participation. 
What we offer you today is a report and also a vision, a vision 
that — when realized — will make this next 10 years one of the 
most productive decades in the College's history. 

My thanks to those who have helped to bring us within striking 
distance of this vision and my best wishes to those who have the 
talent, the will, and the perseverance to see it fulfilled. 



Book List 



New Books In the History of Medicine in 
the Historical Collections of the Library, 
July to December 1991 

JACK ECKERT 

Alain Besson, ed., Thornton's Medical Books, Libraries, and Collec- 
tors: A Study of Bibliography and the Book Trade in Relation 
to the Medical Sciences, third revised edition (Aldershot, En- 
gland, and Brookfield, Vt.: Gower Publishing, 1990). 

James H. Cassedy, Medicine in America: A Short History (Balti- 
more, Md.: Johns Hopkins University Press, 1991). 

David Y. Cooper III and Marshall A. Ledger, Innovation and Tradi- 
tion at the University of Pennsylvania School of Medicine: An 
Anecdotal Journey (Philadelphia, Pa.: University of Pennsyl- 
vania Press, 1990). 

Francesco Cordasco, Homeopathy in the United States: A Bibliog- 
raphy of Homeopathic Medical Imprints, 1825—1925 (Fair- 
view, N.J.: Junius-Vaughn Press, 1991). 

Jacqueline Karnell Corn, Environment and Health in Nineteenth- 
Century America: Two Case Studies (New York: Peter Lang, 
1989). 

Paul F. Cranefield, Science and Empire: East Coast Fever in Rhode- 
sia and the Transvaal (Cambridge: Cambridge University Press, 
1991). 

J. Worth Estes, Dictionary of Protopharmacology: Therapeutic 
Practices, 1700-1850 (Canton, Mass.: Science History Publi- 
cations, 1990). 

John Farley, Bilharzia: A History of Imperial Tropical Medicine 
(Cambridge: Cambridge University Press, 1991). 

Emil J. Freireich and Noreen A. Lemak, Milestones in Leukemia 
Research and Therapy (Baltimore, Md.: Johns Hopkins Univer- 
sity Press, 1991). 

Faye Marie Getz, ed., Healing and Society in Medieval England: A 
Middle English Translation of the Pharmaceutical Writings of 
Gilbertus Anglicus (Madison, Wis.: University of Wisconsin 
Press, 1991). 

107 

Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 107-109 
© 1992 by The College of Physicians of Philadelphia. 



108 Jack Eckert 

Victoria A. Harden, Rocky Mountain Spotted Fever: History of a 
Twentieth-Century Disease (Baltimore, Md.: Johns Hopkins 
University Press, 1990). 

Ernest Heberden, William Heberden: Physician of the Age of Rea- 
son (London: Royal Society of Medicine Services, 1989). 

Christopher Hoolihan, compiler, An Annotated Catalog of the 
Miner Yellow Fever Collection (Rochester, N.Y.: Edward G. 
Miner Library, University of Rochester School of Medicine 
and Dentistry, 1990). 

John F. Hutchinson, Politics and Public Health in Revolutionary 
Russia, 1 890-1 91 8 (Baltimore, Md.: Johns Hopkins University 
Press, 1990). 

Janice M. Irvine, Disorders of Desire: Sex and Gender in Modern 
American Sexology (Philadelphia, Pa.: Temple University Press, 

1990) . 

Lily E. Kay, Molecules, Cells, and Life: An Annotated Bibliography 
of Manuscript Sources on Physiology, Biochemistry, and Bio- 
physics, 1 900-1 960, in the Library of the American Philosoph- 
ical Society (Philadelphia, Pa.: American Philosophical Society, 
1989). 

Johannes de Ketham, The Fasciculus Medicinae of Johannes de 
Ketham, Alemanus, trans. Luke Demaitre (Birmingham, Ala.: 
Classics of Medicine Library, 1988). 

Pearl Kibre, Hippocrates Latinus: Repertorium of Hippocratic 
Writings in the Latin Middle Ages, revised edition (New York: 
Fordham University Press, 1985). 

Lester S. King, Transformations in American Medicine from Benja- 
min Rush to William Osier (Baltimore, Md.: Johns Hopkins 
University Press, 1991). 

Susan E. Klepp, "The Swift Progress of Population": A Documen- 
tary and Bibliographic Study of Philadelphia's Growth, 1 642- 
1859 (Philadelphia, Pa.: American Philosophical Society, 

1991) . 

Ruth Leys and Rand B. Evans, eds., Defining American Psychology: 
The Correspondence between Adolf Meyer and Edward Brad- 
ford Titchener (Baltimore, Md.: Johns Hopkins University 
Press, 1990). 

Floyd Matson, Walking Alone and Marching Together: A History 
of the Organized Blind Movement in the United States, 1940- 
1990 (Baltimore, Md.: National Federation of the Blind, 1990). 



New Books In The Historical Collections 



109 



Pauline M. H. Mazumdar, ed., Immunology, 1930-1980: Essays 
on the History of Immunology (Toronto: Wall & Thompson, 

1989) . 

Deborah Kuhn McGregor, Sexual Surgery and the Origins of Gyne- 
cology: J. Marion Sims, His Hospital, and His Patients (New 
York: Garland Publishing, 1989). 

Carol L. Moberg and Zanvil A. Cohn, eds., Launching the Antibi- 
otic Era: Personal Accounts of the Discovery and Use of the 
First Antibiotics (New York: Rockefeller University Press, 

1990) . 

David B. Morris, The Culture of Pain (Berkeley, Calif.: University 
of California Press, 1991). 

Emily J. Oakhill, A Survey of Sources for the History of Nursing 
and Nursing Education at the Rockefeller Archive Center 
(North Tarry town, N.Y.: Rockefeller Archive Center, 1990). 

Philip R. Reilly, The Surgical Solution: A History of Involuntary 
Sterilization in the United States (Baltimore, Md.: Johns Hop- 
kins University Press, 1991). 

David J. Rothman, Strangers at the Bedside: A History of How 
Law and Bioethics Transformed Medical Decision Making 
(New York: Basic Books, 1991). 

William Schupbach, The Iconographic Collections of the Wellcome 
Institute for the History of Medicine (London: Wellcome Insti- 
tute for the History of Medicine, 1989). 

Melissa A. Smith, compiler, A Survey of Sources for the History of 
Child Studies at the Rockefeller Archive Center (North Tar- 
ry town, N.Y.: Rockefeller Archive Center, 1988). 

Owsei Temkin, Hippocrates in a World of Pagans and Christians 
(Baltimore, Md.: Johns Hopkins University Press, 1991). 

Marcel Tetel, Ronald G. Witt, and Rona Goffen, eds., Life and 
Death in Fifteenth -Century Florence (Durham, N.C.: Duke 
University Press, 1989). 

Michel Valentin, Francois Broussais, 1772-1838: Empereur de la 
Medecine (Dinard, France: Association des Amis du Musee du 
Pays de Dinard, 1988). 



Reviews 



PHILIP R. REILLY. The Surgical Solution: A History of Involun- 
tary Sterilization in the United States. 165 pp. Baltimore, Md.: 
Johns Hopkins University Press, 1991. Price $19.95. 

Reviewed by LEILA ZENDERLAND 

Between 1907 and 1960, more than sixty thousand Americans were 
subjected to surgical sterilization, nearly all without their consent 
and many even without their knowledge. Most of these operations 
took place in institutions for the mentally retarded or mentally ill, 
or in prisons. Their purpose, according to doctors promoting them, 
was largely social: to prevent the birth of additional members of 
the "defective, dependent, and delinquent classes." In The Surgical 
Solution: A History of Involuntary Sterilization in the United 
States, Philip Reilly, a physician and lawyer, has traced the history 
of this movement. By examining a wide range of archival sources, he 
has documented one of the most alarming chapters in contemporary 
medical history. 

Reilly begins his study by examining the belief, widely held in 
the late nineteenth and early twentieth centuries, that not only 
"feeblemindedness" and insanity but also criminality, promiscuity, 
and pauperism were inherited conditions. Within this context, the 
development of relatively safe new sterilization techniques such as 
vasectomy for men (first tried in 1897) and salpingectomy for 
women (first practiced in 1910) led numerous physicians and re- 
formers to advocate a "surgical solution" for pressing social 
problems. 

Most of this book focuses on the ensuing battles to make 
involuntary sterilization legal. Proponents won their first victory in 
Indiana in 1907, when the legislature passed "An act to prevent 
procreation of confirmed criminals, idiots, imbeciles, and rapists." 
Various statutes legalizing sterilization were eventually passed by 
about two-thirds of the states. Among these were Virginia's 1924 
law authorizing physicians to sterilize the "potential parents of 
socially inadequate offspring" and Oklahoma's 1935 "Habitual 
Criminal Sterilization Act." 

Reilly's account relies heavily on the emergence of the eugenics 
movement in explaining both the origins and the dissemination of 

111 

Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 111-128 
© 1992 by The College of Physicians of Philadelphia. 



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these beliefs. While this was largely true in the twentieth century, it 
overlooks the strong influence of older medical theories which actu- 
ally preceded and helped shape eugenic ideas. Among these, for 
instance, were the highly influential theories linking physical with 
moral "degeneration" produced by Dr. Benedict Morel in the nine- 
teenth century. 

This shortcoming is more than offset, however, by Reilly's 
original analysis of this movement's twentieth-century history. His 
book offers a detailed exploration of state and national policies, 
legal arguments and court decisions, well-organized and well-fi- 
nanced lobbying efforts, and equally determined counter efforts to 
block them. 

As a result, the history of sterilization emerges less as a single 
movement than as a complex series of victories and defeats experi- 
enced largely at the state and local level. Proponents won numerous 
legislative victories in the first two decades of this century, only to 
see many of them quickly overturned in state courts. New laws re- 
emerged in the 1920s and were affirmed by the U.S. Supreme Court 
in 1927. The number of operations peaked in the 1930s, when 
the Depression added an even stronger impetus for these medical 
practices justified as a means of curtailing welfare spending. They 
declined again during World War II, however, largely due to a 
shortage of available surgeons. 

Reilly also traces the work of scientists who challenged and 
finally discredited this movement, both before and especially after 
the war, when it became associated with similar practices conducted 
on a far more massive scale in Nazi Germany. Nonetheless, involun- 
tary sterilizations continued, this study proves, in the postwar dec- 
ades, albeit with less publicity. 

Bringing his study up to the present, Reilly explores several 
contemporary legal controversies. Here ironies abound, for recent 
court cases have focused largely on an individual's right to be steri- 
lized. Such suits often involve parents trying to protect mentally 
retarded daughters from harmful pregnancies. In this area of medi- 
cal practice, stringent legal safeguards are needed, the courts have 
argued, precisely because, as one judge declared, this subject had 
such a "sordid history." 

By tracing this history in a clear and concise manner, Reilly 
has contributed an extremely important and timely chapter to the 
larger story of scientific attempts to understand and control knowl- 
edge of reproduction. His book offers a fascinating, frequently ap- 



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113 



palling, and above all chastening lesson about the ways that modern 
surgical advances have proven socially dangerous as well as benefi- 
cial, and about the essential interconnections between medical prac- 
tice, social policies, and human values. 

American Studies Department 
California State University 
Fullerton, CA 92634 

EMIL J. FREIREICH and NOREEN A. LEMAK. Milestones in 
Leukemia Research and Therapy. 195 pp. Baltimore, Md.: Johns 
Hopkins University Press, 1991. Price $60.00. 

Reviewed by JACALYN DUFFIN 

Two hundred years ago, leukemia was unknown. Fifty years ago, 
it was recognized as the most rapidly fatal of human diseases. In 
July 1991, the New England journal of Medicine published an 
article on the health of offspring born to former chemotherapy 
patients, some of whom had been cured of childhood leukemia. 1 
Clearly, radical changes in the medical understanding of the various 
forms of this disease have occurred in the recent past; however, until 
now, there has been no review of these achievements. Leukemia 
researchers Emil J. Freireich and Noreen A. Lemak initially planned 
to fill the void with an article, but their work quickly expanded into 
this welcome book Milestones in Leukemia Research and Therapy. 
As the title suggests, the purpose of this volume is not "history"; 
indeed, the only secondary source cited is Edward Shorter's The 
Health Century (New York: Doubleday, 1987). Instead, the authors 
present the evolution of major changes in the concept and treatment 
of leukemia. With their intimate understanding of the disease, the 
clarity of their presentation, and the judicious use of citation from 
original articles, they succeed splendidly. 

In 1845, Rudolph Virchow and J. Hughes Bennett engaged 
in a priority dispute over their near simultaneous descriptions of 
leukemic patients. Virchow gave the disease its name and his de- 
scription of the pathogenesis more closely approximates the current 



1. Daniel M. Green, Michael A. Zevon, Geoffrey Lowrie, Nina Seigelstein, and 
Brenda Hall, "Congenital Anomalies in Children who Received Chemotherapy for 
Cancer in Childhood and Adolescence," New England Journal of Medicine, 1991, 
325:141-146. 



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view. The sinister prognosis of this newly recognized disease quickly 
became all too plain. At first, varieties of leukemia were identified 
on anatomical grounds (e.g., splenic, lymphatic, and myelogenous); 
later, leukemia diagnosis shifted to accommodate advances in mi- 
croscopy and cell biology. Factors affecting incidence, including the 
1945 atomic assault on Japan, as well as past and contemporary 
notions concerning causation are presented, from radiation to vi- 
ruses and oncogenes. The discovery and development of each of 
the main therapies for leukemia is succinctly explained. The rela- 
tionship of this disease to its larger scientific context is addressed, 
with specific reference to the funding provided to American research 
institutions and the impact of public clamor on development of new 
treatments, such as interferon. 

Only in the chapter on recombinant DNA and molecular analy- 
sis, does the presentation slip into a "who, when, what" style, 
common with many "milestone" formats. Recognizing that the con- 
tent of this chapter may seem "irrelevant to leukemia" (p. 187), the 
authors justify its presence by stating that molecular genetics has 
already assumed a large role in leukemia research and that there 
has been no other review of these techniques. 

Freireich and Lemak note that an absolute cure for all forms 
of leukemia would have only a tiny effect on global mortality. 
Nevertheless, Milestones makes it clear that the study of these rela- 
tively rare disorders has engaged the energies of a host of Nobel 
laureates and that the related discoveries have altered many aspects 
of biological science. 

Perhaps the most significant contribution of this volume is the 
reference section, which stands as a well-selected bibliography of 
leukemia research. Graceful epigraphs, gentle humor, and illustra- 
tions enhance the work. Most photographs are portraits of leuke- 
mia researchers, with the notable exception of the first published 
image of a leukemia patient who died in 1862: a solemn child with 
massive adenopathy and a riveting gaze. This timely book is an 
accurate account of interest to physicians and researchers, accessible 
to historians, and the first step in the process of writing the long 
overdue history of leukemia. 

Hannah Chair of the History of Medicine 
Queen's University 
Kingston, Ontario K7L 3N6 
Canada 



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115 



ALLEN B. WEISSE. Medical Odysseys: The Different and Some- 
times Unexpected Pathways to Twentieth-Century Medical Discov- 
eries. 250 pp. New Brunswick, N.J.: Rutgers University Press, 1991. 
Price $13.95. 

Reviewed by ROBERT H. BRADLEY, JR. 

Publishers rely on the public's insatiable appetite for mystery and 
medicine. What reader can resist a well-told detective story? Throw 
in a medical theme, and literary success is assured. This being so, 
Allen B. Weisse has produced a winner with Medical Odysseys: 
The Different and Sometimes Unexpected Pathways to Twentieth- 
Century Medical Discoveries. Weisse is a practiced story teller as 
well as a cardiologist and professor of medicine at the New Jersey 
College of Medicine and Dentistry. His long-time interest has been 
to find and report the full story behind the great medical develop- 
ments of the twentieth century. This book is not fiction, but these are 
stories that no fiction can approach for excitement, perseverance, 
daring, and human interest. 

In his introduction titled "How Do Discoveries Happen" 
Weisse observes that serendipity or accidental discovery is rare. 
Hard work and good luck are more often the rule. Researchers are 
frequently characterized in the public's mind as persons of genius, 
daring, and persistence, which may be so, but their work is fre- 
quently encumbered by ambition, competition, obtuse authority, 
politics and war, anger and danger, and money or the lack of it. 
Weisse also points out that many, if not most, research advances 
rest on principles or observations made years, decades, or even 
centuries before. In this respect he quotes Sir Isaac Newton: "If I 
have seen further, it is by standing on the shoulders of giants." 

Although Weisse focuses principally on the major discoveries 
of this century made by such well-known workers as Fleming, 
Gross, Minot, Kolff, Salk, Sabin, Enders, and Gibbon, his stories 
also cover in depth the less famous and equally talented individuals 
whose work provided the foundation or impetus for the ultimate 
triumphs. Weisse's contemporaneous medical experience and his 
personal acquaintance with many of the individuals about whom 
he writes contribute both balance and authority to his narrative. 
The chapter on poliomyelitis is a case in point. In it he describes 
the two different approaches to the successful conquest of polio, 
and then adds a thoughtful essay on the complex personalities of 
the two men credited with this great achievement. 



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Medical Odyssey s has 12 chapters, each devoted to progress 
or success in managing a particular disease or clinical problem. 
The book begins with mercurial diuretics, and continues through 
hepatitis viruses, surgery for heart disease, and the discoveries of 
penicillin, the artificial kidney, and the artificial heart. Weisse then 
pauses with an essay on negative research, or how much of what is 
taught is wrong. He then continues with chapters on pernicious 
anemia, chemotherapy, electrocardiology, poliomyelitis, immunol- 
ogy, and Legionnaire's disease. 

In the last two chapters, Weisse writes of the proliferation of 
new syndromes striving for respectability which at least afford an 
escape route for harried practitioners in dealing with unexplainable 
symptoms. He concludes by reminding the reader that there are no 
limits to the research that needs to be done, and that although half 
of it may be accomplished by meticulous reasoning, the rest will be 
the result of blind wandering. 

I recommend this book for both pleasant reading and also as 
a contribution to source material in recent medical history. 

7913 Crefeld Street 
Philadelphia, PA 19118 

ROBERT GALLO. Virus Hunting: AIDS, Cancer, & the Human 
Retrovirus: A Story of Scientific Discovery. 336 pp. New York: 
Basic Books, 1991. Price $22.95. 

Reviewed by ROBERT G. SHARRAR 

The fact that we have learned so much about AIDS in a relatively 
short period of time is the accomplishment of many talented and 
dedicated people. One of these individuals is Dr. Robert Gallo, who 
has written a highly personal book, entitled Virus Hunting: AIDS, 
Cancer, & the Human Retrovirus: A Story of Scientific Discovery. 
The author's "main intent in telling this story has been to portray 
the scientific process as it goes on in our time and to describe 
the process of discovery in biomedical research in at least one 
laboratory" (p. 7). 

Gallo begins with a brief personal history of how he became 
interested in the field of medicine and in clinical research, followed 
by a brief history of the National Institutes of Health. The second 
part of the book describes the discovery of the first two retroviruses 



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117 



as causes of human cancers. This section is especially interesting 
because it demonstrates how the scientific process and the interna- 
tional scientific community actually work. It shows that scientific 
knowledge moves forward by sharing observations and defending 
ideas in an open forum. In this section of the book, he describes the 
physical characteristic of a retrovirus and explains how it produces 
disease. It should serve as a primer for anyone who is interested in 
understanding the pathogenesis of HIV infections. 

In the third section of the book, Gallo describes the events 
leading to the discovery of the third retrovirus as the cause of 
AIDS. It is of interest to note that the earliest detection of reverse 
transcriptase activity in an AIDS patient by Gallo's laboratory oc- 
curred in May 1982, and that a number of viral isolates were 
identified by the summer of 1983. Over the next several years his 
laboratory made significant contributions, i.e., the development of 
a defined immortalized cell line which could continuously produce 
virus, and the serologic tests to identify HIV antibodies. Researchers 
there also played a major role in demonstrating the molecular struc- 
ture of the virus, its heterogeneity, the presence of viremia, and the 
fact that the virus could infect T4 lymphocytes and macrophages. 

In the final section, Gallo presents his version of the science 
and politics of AIDS. Much of what he says is based on factual 
data, but he also adds his own personal interpretation of frequently 
asked questions about AIDS, the pathophysiology of HIV infection, 
the development of Kaposi's sarcoma, and the cause of AIDS. In 
the final chapter, he talks about what has or could be done to control 
the AIDS epidemic and HIV infection. This section is especially 
interesting because it links all of the known scientific facts into a 
comprehensive whole explaining how HIV causes clinical disease in 
humans. 

In order to understand history, one has to view historical events 
from different perspectives. This is one man's perspective of one of 
the most important public health events in this century. However, 
this one man played a major role in developing laboratory tech- 
niques to study retroviruses in the 1970s which made it possible for 
medical science to isolate, identify, and study the virus that caused 
AIDS in the 1980s. One wonders what sort of impact the AIDS 
epidemic would have had on the population if it were not for the 
process and progress of scientific discovery described in this book. 
Although the book is informative, it is not always easy to follow. 
At times it rambles, and burdens the reader with numerous names 



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that are hard to remember. However, Gallo's perspective is one that 
should not be missed. 

2142 Mt. Vernon Street 
Philadelphia, PA 19130 

OWSEI TEMKIN, trans. Soranus' Gynecology. 207 pp. Baltimore, 
Md.: Johns Hopkins University Press, 1991. Price $18.95. 

Reviewed by A. DEBORAH GOLDSTEIN 

The re-issue in soft cover of Owsei Temkin's Soranus' Gynecology, 
originally published in 1956, is most welcome, appearing at a time 
of heightened interest in both ancient medicine and women's stud- 
ies. This reprint is the only English translation of Soranus' Gynecol- 
ogy currently available. 

Temkin begins with an accurate assessment of the Greek physi- 
cian from Ephesus, who practiced at Rome in the early second 
century just before the time of Galen, calling Soranus "one of the 
most learned, critical, and lucid authors of antiquity" (p. xxiii). The 
introduction reviews what little is known of Soranus, and contains 
a brief discussion of the major schools of medicine of his time, 
with emphasis on the Methodist sect to which Soranus belonged, a 
textual history, and an overview of the Gynecology. There is also 
a glossary of ancient names and a 30-page materia medica pertinent 
to the Gynecology. 

The Gynecology deals with anatomy, menstruation, dysmenor- 
rhea, contraceptives and abortifacients, pregnancy, labor and deliv- 
ery (including the obstetric chair and dystocia), and care of the 
newborn. Soranus recognized that amenorrhea could be secondary 
to exercise and anticipated our modern (re)discovery of patient- 
assisted delivery: "one must advise her to drive her breath into the 
flanks . . . with groaning and detention of the breath ... to compress 
[her] breath . . . [and] to strain most when [the pains] are present" 
(pp. 74-75). 

Soranus's reasoned yet humane approach is evident through- 
out. The best midwife, for example, will "be able to state clearly 
the reasons for her measures . . . bring reassurance to her patients, 
and be sympathetic" (p. 6). Similarly, superstitious and unsound 
practices are routinely denounced. Both wine and "the urine of an 
innocent child" are condemned as cleansing baths for the newborn: 



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119 



"we, however, reject all of these . . . the wine, because of its effluvia, 
causes stupor . . . and the urine, likewise, because it is ill-smelling" 
(pp. 82-83). Pediatricians will be intrigued further by the recogni- 
tion and treatment of thrush, exanthemata, wheezing, coughing, 
and "flux" of the bowels. 

Soranus was a prolific author whose treatises are preserved 
largely through the efforts of ancient translators and compilers. The 
Gynecology is one of the few texts available in the original Greek. 
Two physicians are responsible for recognizing the importance of 
the manuscript: Friedrich Reinhold Dietz, in 1830, and Franz Za- 
charias Ermerins, who in 1869 published an attempt to reconstitute 
the original. Finally, the classical philologist Johannes Ilberg pub- 
lished in 1927 the Greek text of Soranus's Gynecology in Volume 
IV of the Corpus Medicorum Graecorum. Temkin's translation is 
based on Ilberg's text. 1 

Soranus has not been ignored in the 35 years since the original 
appearance of this volume. The 1988 addition to the Bude series 
(Paul Burguiere, Danielle Gourevitch, and Yves Malinas, eds., Sor- 
anos d'Ephese, Maladies des Femmes, Tome I (Paris: Les Belles 
Lettres, 1988) presents the Greek text and a translation into French. 
The editors include the first chapter of Ilberg's Book II, re-arrange 
some of the rest, add 10 passages athetised by Ilberg (arguing for 
inclusion on the grounds of stylistic analysis), and append three 
essays and an extensive bibliography. 

939 Sulgrave Lane 
Bryn Mawr, PA 19010 

J. WORTH ESTES. Dictionary of Protopbarmacology: Therapeutic 
Practice, 1700-1850. 229 pp. Canton, Mass.: Science History Pub- 
lications, 1990. Price $49.95. 

Reviewed by JOHN HARLEY WARNER 

The past decade has witnessed a striking growth of interest in the 
history of medical therapeutics, especially in the era before the 
experimental laboratory began to yield such recognized symbols of 
therapeutic success as diphtheria antitoxin, salvarsan, and insulin. 



1. Some of Ilberg's text had been translated by Kenneth Scott and appeared in 
Herbert Thorns, ed., Classical Contributions to Obstetrics (Springfield, 111.: Charles 
C Thomas, 1935). 



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Rather than dismissing earlier practices as risible or deplorable, 
historians have sought to understand the mentality that gave them 
meaning for healers and sufferers at the time. As more and more 
historians have endeavored to glean information from such records 
of eighteenth- and nineteenth-century therapeutic activity as hospi- 
tal patient charts and private practice day books, they have shared 
the frustration of trying to master a technical language largely un- 
spoken for more than a century, one that is often baffling to the 
modern clinician and cultural historian alike. 

J. Worth Estes's Dictionary of Protopharmacology: Therapeu- 
tic Practice, 1700—1850 provides a much needed guide to that lan- 
guage. Drawing heavily on dispensatories and textbooks, Estes has 
assembled information on some three thousand terms common in 
the Anglophone physician's therapeutic vocabulary before 1850. 
Most of the entries are botanical or mineral remedies that were part 
of the orthodox armamentarium, but important non-drug therapies 
(such as bloodletting, electricity, and diet) are also included, as are 
some sectarian treatments and patent medicines. And, as Estes aptly 
points out in his short introduction, there was substantial overlap 
between the remedies used in domestic and professional practice. 
For each therapeutic agent, the author defines its ingredients and 
preparation, explains how it was thought to affect the body, gives 
selected synonyms, and, sometimes, indicates how it first entered 
the materia medica. Throughout, he uses terms and conceptual 
categories that reflect the belief system of practitioners who em- 
ployed these agents, and ordinarily refrains from giving the modern 
concepts of the drug's pharmacological effects. So too, he says little 
about the diseases for which each drug was recommended, a choice 
that recognizes the fluidity of disease entities and the doubtful legiti- 
macy of disease-specific therapy in the early modern medical mind. 
Additional entries include colloquial names for certain therapeutic 
agents, the units of measure used in preparing and prescribing 
drugs, the categories by which drugs were classified (usually by 
action, as in the case of an emetic or a sudorific), and common 
abbreviations. 

The usefulness of this dictionary could have been greatly en- 
hanced by providing fuller access to the historical literature that has 
explored how various therapeutic agents were deployed, both in 
professional polemics and at the bedside. Some entries refer the 
reader to a list of general references, but the list is brief and reflects 
a highly idiosyncratic vision of the extant secondary literature: the 



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121 



entry on calomel, to cite a typical example, directs the reader to 
two secondary works, both by Estes, whereas the reader would 
have been better served by additional references to articles by, 
among others, Alex Berman, John Haller, and Guenter Risse. This 
is nonetheless a very welcome volume, making readily available 
information that hitherto each researcher has had to track down 
and organize on his or her own. It belongs on the reference shelf of 
everyone who sets out to explore eighteenth- and nineteenth-cen- 
tury pharmacy and medical therapeutics. 



WENDY MITCHINSON. The Nature of Their Bodies: Women 
and Their Doctors in Victorian Canada. 363 pp. Toronto, Canada: 
University of Toronto Press, 1991. Price $22.95. 



Reviewed by RIMA D. APPLE 



Section of the History of Medicine 
Yale University School of Medicine 
333 Cedar Street 
New Haven, CT 06510 



Wendy Mitchinson's The Nature of Their Bodies: Women and Their 
Doctors in Victorian Canada begins with the premise that "medicine 
and culture go hand-in-hand and that one way of discovering atti- 
tudes towards women is to examine their medical experience" (p. 7). 
Dealing with English-speaking Canada, the book outlines medical 
explanations for women's supposed physical weaknesses and ill- 
health, the ways doctors viewed changes in the female body over 
the life-span and women's susceptibility to insanity, the reactions of 
medical practitioners to birth control and abortion, and the creation 
and development of medical specialties dealing specifically with 
women's health concerns, namely obstetrics, gynecology, and gyne- 
cological surgery. 

Canadians of the Victorian period held the idea of science in 
high regard. Physicians cultivated the popular view of medicine as 
scientific, which endowed their work with a sense of "scientific 
objectivity." The connection between medicine and science rein- 
forced the interventionist side of medicine, while denying its cultural 
basis. For physicians and for other Canadians, men and women 
were different, but man was the norm and woman's complex repro- 
ductive system was the basis of all her health problems, physically, 



122 



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emotionally, and intellectually. The focus on her reproductive sys- 
tem made woman's ill-health seem "natural" and inescapable. Physi- 
ological functions such as menstruation, pregnancy, and menopause 
were seen as problematical, if not pathological. Physicians recog- 
nized that social and cultural conditions caused disease in women 
and, not surprisingly, their views of the world conditioned their 
ideas of health. Thus, their criticism of contemporary fashion re- 
veals doctors' uneasiness with modern society and the roles of 
modern women, in addition to their medical concerns. 

The focus of the book is the second half of the nineteenth 
century, a period of rapid and dramatic change in the medical 
world. Mitchinson gives little indication of such changes when she 
discusses issues such as female frailty and interpretations of female 
physiology. Her chapters on obstetrics, gynecology, and gynecologi- 
cal surgery, chapters in which she skillfully uses hospital records and 
physicians' writings, more clearly delineate the increasing medical 
intervention and medicalization of women's health conditions. 
Early in the nineteenth century, physicians were unwilling to exam- 
ine female patients tactilely or visually; by the end of the century, 
however, such examinations were considered necessary and com- 
monplace. This change reflects a shift in doctor's views; as the 
benefits of examination and treatment became clearer, physicians 
no longer viewed themselves as males who needed to protect a 
woman's virtue, but more as professionals. 

The subtitle of Women and Their Doctors suggests that the 
reader will learn not only about what male physicians thought and 
did, but also what female patients thought and did. (Mitchinson 
explains that only a minuscule number of physicians were female 
throughout the entire period of review.) Unfortunately, the patients 
are generally silent. We hear female patients almost exclusively 
through doctors' records and institutional reports, in which the 
patients are often portrayed as relatively passive victims. Mitchin- 
son claims that women's actions helped to shape the medical care 
they received, but how? 

Mitchinson's sources clearly show the interconnectedness of 
the English-speaking medical world in the late nineteenth century. 
The books used in Canadian medical schools were published in the 
United States and Britain, as well as Canada; the articles published 
in Canadian journals were penned by Canadians, as well as re- 
printed from American and British sources; physicians practicing 
in Canada were trained in the United States and Britain, as well as 



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123 



Canada. What her study tells then is not a uniquely Canadian story, 
but one that deepens our understanding of the role of culture in 
maintaining and refining gender roles and medical experiences. 

Department of the History of Medicine 
University of Wisconsin-Madison 
1300 University Avenue 
Madison, WI 53706 

KATHRYN MONTGOMERY HUNTER. Doctors' Stories: The 
Narrative Structure of Medical Knowledge. 173 pp. Princeton, N.J.: 
Princeton University Press, 1991. Price $24.95. 

Reviewed by JULIA EPSTEIN 

Doctors' Stories: The Narrative Structure of Medical Knowledge, 
by Kathryn Montgomery Hunter, offers a careful, detailed, and 
often brilliant ethnography of the complex intellectual processes of 
clinical diagnosis and clinical education. Hunter, a professor in the 
ethics and human values in medicine program at Northwestern 
University Medical School, was trained in English literature and 
has been a pioneer in the development of courses in the medical 
humanities. Hunter is a keen observer, and she brings to bear a 
sophisticated understanding of the nature of storytelling to her 
examination of the ways physicians speak to each other, teach 
medical students, keep records of their patients, and write up their 
cases. Hunter proposes that a well-developed narrative method is 
at the center of clinical medicine, and that physicians are "highly 
trained, critical readers of the text that is the patient" (p. 4). 

Other scholars and physicians have been paying attention to 
the ways patients become cases, and have argued that diagnostic 
reasoning both necessarily constructs patients as objects of study, 
and sometimes, as a consequence, ends up objectifying patients in 
dehumanizing language. Hunter's work in Doctors' Stories comple- 
ments the recent writings of Howard Brody {Stories of Sickness 
[New Haven: Yale University Press, 1987]) and Arthur Kleinman 
{The Illness Narratives: Suffering, Healing, and the Human Condi- 
tion [New York: Basic Books, 1988]). While Brody focuses on liter- 
ary representations of illness and Kleinman investigates the life 
stories of the chronically ill, Hunter turns her attention to attending 
physicians, residents, and medical students in tertiary care centers. 



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In her analysis of the variety of ways physicians communicate their 
knowledge to each other, she looks in turn at the functions of 
anecdotes, charts and case reports, and clinical-pathological confer- 
ences and syndrome letters, and applies the critical tools of narrative 
and historiographical theory. 

Using passages from the Sherlock Holmes stories of Arthur 
Conan Doyle as epigraphs for each chapter, Hunter argues that "the 
semiotics of detection are precisely those of medicine" (p. 169). But 
she also goes well beyond that analysis of clinical reasoning, calling 
for a "richer narrative than the traditional medical case" (p. 149) 
in "this era of chronic, environmentally induced, and psychosomatic 
illness" (p. 128). The most exciting section of this fine study comes 
in a chapter that uses the example of the Bororos of South America, 
who believe that they become red parakeets at their death. Anthro- 
pologists have appealed to this example as "an epitome of the 
incommensurability of our discourse and theirs" (p. 124). Hunter 
asserts that there is also a fundamental and inevitable incommensu- 
rability between a patient's experience of illness and the clinical 
narrative produced by the physician. She analyzes the way in which 
physicians return the patient's story to the patient by giving back 
an interpreted version of that story in the forms of a diagnosis, a 
suggestion of therapy or abstinence, or reassurance. 

Hunter wants physicians to hear, acknowledge, and narrate the 
full texture of their patients' lives, and she has made an extraordi- 
nary contribution to clinical medicine by demonstrating in such 
detail the means that already exist in hospital medicine for taking 
account of patients' minds and lives as well as their bodies. 

Department of English 
and Comparative Literature 
Haverford College 
Haver ford, PA 19041 

EDWARD NORBECK and MARGARET LOCK, eds. Health, Ill- 
ness, and Medical Care in Japan: Cultural and Social Dimensions. 
188 pp. Honolulu, Hawaii: University of Hawaii Press, 1987. Price 
$21.00. 

Reviewed by ANN BOWMAN JANNETTA 

Health, Illness, and Medical Care in japan: Cultural and Social 
Dimensions, edited by Edward Norbeck and Margaret Lock, is a 



Reviews 



125 



collection of seven essays dealing with selected topics related to 
health and illness in contemporary Japan. The authors — five an- 
thropologists and one political scientist — are interested in Japanese 
attitudes towards health, illness, and medical care. Margaret Lock's 
introductory chapter discusses the concept of "medicalization" — 
a term that is widely used in anthropological discourse but which 
resists precise definition. In this volume the term is used to describe 
the extension of medical approaches and interventions into life 
situations where there is no obvious pathology. Medicalization is a 
prominent theme in almost all of the articles, and, according to the 
authors, is well advanced in Japan and has produced a rising de- 
mand for medical services of all kinds. 

Whatever the problems of health and illness in contemporary 
Japan, they must be viewed within the context of Japan's postwar 
"health miracle." William Steslicke's chapter on "The Japanese State 
of Health" provides this context for the reader. He documents 
the epidemiological shift in Japan from acute infectious to chronic 
degenerative diseases, and Japan's transition from high to low mor- 
tality rates. Today Japan has the highest life expectancy and the 
lowest infant mortality rates in the world — a remarkable achieve- 
ment by any standard — and many of Japan's current health prob- 
lems are a direct consequence of this success. 

Christie Kiefer's chapter on "Care of the Aged" discusses the 
consequences of longer life expectancy. She presents a chilling ac- 
count of the speed with which new medical technologies have pro- 
duced a large and dependent elderly population that faces what the 
Japanese call "the ugly decline." Susan O. Long's chapter on "Health 
Care Providers" analyzes the historic relationship between Japan's 
influential community of physicians and the government health 
bureaucracy. David A. Reynolds's essay discusses "Japanese Models 
of Psychotherapy" including two — the Morita and Naikan thera- 
pies — which are distinctively Japanese. 

Two of the essays, by Lock and Nancy R. Rosenberger, con- 
sider the relationship between social problems and health problems 
that are peculiar to women. In "Protests of a Good Wife and Wise 
Mother: The Medicalization of Distress in Japan," Lock claims 
that what is essentially a social problem — limited opportunity 
for women to participate as individuals in Japanese society — is 
exhibited as a medical problem, which is culturally more acceptable. 
Rosenberger suggests that in Japan "middle-aged women use ideas 
and actions about menopause to control their image in relation to 



126 



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the household" (p. 181). Village women who play an important 
economic role in their households regard the menopause as the 
end of a woman's reproductive but not her productive role in the 
household. City women are more likely to regard menopause as a 
time when household responsibilities should diminish so that they 
can participate in activities outside the household. 

The essays in this volume cover topics of universal interest, 
have excellent bibliographies, and contain a wealth of information 
that should be of interest to public health specialists, medical histo- 
rians, sociologists, medical and cultural anthropologists, and jour- 
nalists who write about contemporary affairs. 

Department of History 
University of Pittsburgh 
Pittsburgh, PA 15260 

WILLIAM J. ELLOS. Ethical Practice in Clinical Medicine. 172 pp. 
New York: Routledge, Chapman & Hall, 1991. Price $15.95. 

Reviewed by DAVID G. SMITH 

The growth in medical ethics literature over the past two decades 
creates serious difficulties for the practicing physician or medical 
student if he or she desires a quick primer. During the 1970s, the 
typical book was an anthology of specific articles dealing with 
topics such as autonomy, beneficence, truth-telling, euthanasia, 
abortion, and research. A brief introduction to each topic was usu- 
ally written by a single author and most such texts included perti- 
nent clinical cases. The next generation of texts explored the 
philosophical foundations of medicine and the doctor-patient 
relationship. 

A new generation of texts has now started to explore some 
basic philosophical approaches to dilemmas in medicine. The dis- 
cussion of the applications of casuistry and virtue to medical ethics 
is extremely interesting but clearly beyond the scope of most practic- 
ing physicians who require a quick introduction and update. From 
a more practical perspective, Jonsen, Siegler, and Winslade have 
published a manual of clinical ethics along the line of a number of 
quick reference sources to guide action at the bedside (Clinical 
Ethics, Macmillan, 1986). Where then should Ethical Practice in 
Clinical Medicine, by William Ellos, be inserted? Is it a quick refer- 



Reviews 



127 



ence or is it more fundamental in its orientation? The answers to 
these questions are important if this book is to find a niche in an 
already crowded field. 

The introduction to the book states that ". . . because this text 
is designed to be used by the busy health practitioner, the theoretical 
material is kept clear, brief and to the point . . . the clinical cases 
[are] crisp and concise . . . . " Using this as my introduction, I started 
to read the chapter on the Platonic Foundation. The concept of 
virtue is presented along with several case studies. One case is of a 
physician confronted with a terminally ill patient who requests an 
increase in her "pain killing drugs." Ellos tries to swirl a discussion 
on the Platonic dialogues around this dilemma utilizing concepts of 
virtue, the lawmaker, moderation, and courage. As is true of most 
cases provided in the book, a few provocative questions follow 
the case presentation with little or no attempt to use the basic 
philosophical discussion. These cases may be good to provoke a 
discussion in a classroom setting, but a "busy health practitioner" 
is clearly not going to spend a tremendous amount of time trying 
to apply the thin discussion of the Platonic dialogues to these cases; 
nor could he or she without additional reading from other sources. 
A practical ethical approach to a patient requesting a suicidal dose 
of painkillers would deal with the principle of double effect and 
the current legal prohibitions against physician assisted suicide. 
Although reading and understanding Plato may be illuminating, 
busy practitioners usually need more directed reading. 

A related concern is the relevance of some of the philosophical 
foundations to discourse in medical ethics. Although interesting in 
a basic course surveying the development of moral philosophy, there 
is little doubt that the basic schools covered in this text have little 
immediate relevance to the bedside dilemmas. 

A small criticism relates to errors in some of the case presenta- 
tions. For example, on page 60 a physician is quoted on the prob- 
lems of working within a HMO setting. She is alleged to have 
said that ". . . another problem was that I was under pressure to 
encourage my patients to undergo procedures, since that's where 
the money's at .... " Actually, the opposite is true when working 
within a prospective reimbursement setting. On page 67, the author 
states that ". . . in their state, the law prohibits shutting off the 
respirator until the patient is weaned . ..." I am not aware of any 
state which precludes a competent adult from having his request 
for discontinuation of a ventilator respected. A reference or some 



128 



Reviews 



note concerning this assertion would be helpful. On page 88, a 
"serum 12" probably is a "vitamin B12" level. Some of the cases 
beg for greater discussion concerning the appropriateness of the 
choices. For example, a radiologist discusses the results of a X-ray 
showing newly diagnosed cancer with a patient; a resident sabotages 
a decision by patient and family concerning extubation of a seri- 
ously ill patient; a physician acts to restrict care because of the fear 
of administrative sanctions concerning the loss of revenue through 
continued care to the patient. 

Despite some of the above problems, the cases represent some 
of the most typical dilemmas which rarely get the serious attention 
in the academic journals. Although it would be easy to dismiss these 
clinical vignettes as just examples of bad cases which should not be 
used in formal ethics teaching, they represent the bread and butter 
reality of most practicing clinical ethicists. 

Several questions need to be answered. Who should buy and 
read this book? This book would be most useful as a basic text in 
an undergraduate course supplemented by additional reading in the 
specific philosophical traditions. As a coordinator of a course in 
medical ethics at a medical school, I am not sure that this text 
would work well in a required course with limited course hours. I 
am quite certain that this book is woefully inadequate for the "busy 
health practitioner," not because such an individual would not bene- 
fit from reading this text, but because it lacks any of the specific 
guidelines developed for such ethical problems as DNR decisions, 
advance directives, withdrawing or withholding life support, dura- 
ble power of attorney, etc. Most clinicians should probably consult 
pertinent articles in the clinical literature or access the information 
through their local ethics consultant or ethics committee. However, 
this book may be quite appropriate for those autodidacts who re- 
quire a basic philosophical primer as a prelude to an immersion in 
a more in-depth analysis. 

Abington Hospital 
1200 Old York Road 
Suite 2B 

Abington, PA 19001 



Memoir 



Memoir of C. William Hanson, Jr., 
1929-1991 

ORVILLE HORWITZ 

C. William (Bill) Hanson, Jr. was born in Poughkeepsie, New York, 
on 8 July 1929. He graduated from Cornell University in 1951, and 
then attended the University of Pennsylvania School of Medicine, 
obtaining a degree in medicine in 1955. After graduating from 
medical school, Bill spent the rest of his professional life — except 
for the years 1957-1959 which he spent in Athens, Greece, and 
Washington, D.C., as an officer of the United States Navy — affili- 
ated with the Hospital of the University of Pennsylvania (HUP). In 
addition, he was also once associated with the CIA. 

I first met Bill in 1954, when he was a medical student. I later 
knew him in his capacity as an intern, a resident, a research fellow, 
a chief medical resident, and a tenant in my own office. He became a 
life-long friend as well as my personal physician. We were members 
together of the "Sons of the Copper Beeches," a Sherlock Holmes 
Society in which Bill usually won all the quiz prizes. 

Bill's most memorable characteristic was his consistently su- 
perb set of values. To him, the care of the patient was always the 
most important consideration in medicine. Bill was always very 
conscious of this point. He was also an excellent teacher and edited 
a splendid book entitled Toxic Emergencies (New York: Churchill 
Livingstone, 1984). He knew the medical literature well and was 
very interested in research, but not in the performance thereof. His 
major teaching and clinical responsibilities, as he once listed them, 
were: 

1. Attending physician in emergency medicine, with two-to- 
four students per month. 

2. Attending rounds in Medical In-Patient Service one month 
per year. 

3. Various lesser commitments, including acting medical direc- 
tor of the Student Health Service; member of the Infectious 
Disease Section; emergency room physician and director 



129 



Transactions & Studies of the College of Physicians of 
Philadelphia, Ser. 5, Vol. 14, No. 1 (1992); 129-130 
© 1992 by The College of Physicians of Philadelphia. 



130 



Memoir 



of Emergency Services; recording secretary of the Medical 
Board and Executive Committee; member of the Profes- 
sional Quality Assurance Committee; member of the Cre- 
dentials Committee; member of the Technical Advisory 
Committee, the Philadelphia Poison Control Center; associ- 
ate medical command physician, the Trauma Service; and 
innovator and director of the new Health Evaluation 
Center. 

Bill was always available to chair any committee which was 
known for its drudgery, and about which no one else was too 
enthusiastic. His presence and directorship of these committees gave 
them prestige and, unbelievably, popularity. He was a favorite medi- 
cal consultant of physicians and surgeons, certainly for their pa- 
tients, and usually for themselves. 

Bill married the former Ann Morgan in 1954, and fathered a 
family of five, fine children — the eldest of whom, C. William 
Hanson, III, is an associate in anesthesiology at HUP. Bill and his 
wife Ann were active at HUP as well as in the College of Physicians 
of Philadelphia, where Bill was chairman of the Program 
Committee. 

In closing, I quote from the annual report of the Foundation for 
Vascular-Hypertension Research, of which Bill was a staff member: 

Members of the foundation and especially members of the 
staff of the Hospital of the University of Pennsylvania and, 
most especially, his patients, were shocked to learn of the 
sudden death of Dr. C. William Hanson on Saturday, Septem- 
ber 28, 1991. It is often stated that no one is irreplaceable, but 
Bill Hanson came as close as anyone to that category. We have 
all lost a magnificent man, a loyal friend, and a truly great 
physician. 



Two Private Way 
Strafford, PA 19087 



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EXAMPLES 

William H. Helfand, Medicine and Pharmacy in American Political Prints 
(Madison, Wis.: American Institute of the History of Pharmacy, 1967), p. 
35. 

Helfand, Medicine and Pharmacy, p. 51. 
Ibid., p. 60. 

Wendy Shadwell, "Britannia in Distress," American Book Collector, 1986, 
7:1. 

A complete set of instructions will be sent, upon request, to authors. 



TRANSACTIONS & STUDIES 
OF THE 

COLLEGE OF PHYSICIANS OF PHILADELPHIA 

Series V Volume XIV Number 1 March 1992 

MEDICINE AND HISTORY 

Contributors to This Issue v 

The Emergence of Medical Malpractice 
in America 

JAMES C. MOHR 1 

Revolt Against Quarantine: Community 
Responses to the 1916 Polio Epidemic, 
Oyster Bay, New York 

GUENTER B. RISSE 23 

A Tale of Pursuing Health Deception 

JAMES HARVEY YOUNG 51 

FROM THE FELLOWSHIP 

James W. Kennedy, M.D. and the Joseph 
Price Memorial Hospital: Recollections 

FREDERICK MURTAGH 73 

FROM THE HISTORICAL COLLECTIONS 

"An Indescribable Feeling of Wretchedness": 
Letters to Samuel Jackson on Epilepsy 

JACK ECKERT 83 

Report of the President of the College 
of Physicians at the Annual Meeting of 
the Fellowship, 26 November 1991 

DANIEL L. SHAW, JR. 101 

BOOK LIST 107 
REVIEWS 111 



MEMOIR 



129